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目的:归纳分析42例隐球菌脑膜炎的发病情况、临床特点并总结抗真菌药物的治疗经验,以提高对隐球菌脑膜炎的诊治水平。方法:回顾分析四川大学华西医院2001～2007年所收治42例隐球菌脑膜炎病例的临床表现、实验室检查结果、抗真菌药物的疗效及预后,并对两性霉素B联合5-氟胞嘧啶抗真菌治疗的药物剂量、疗效、不良反应以及疗程与预后的关系加以剖析。结果:临床以发热、头痛、颅内压升高、脑膜刺激征为主要表现,采用两性霉素B联合5-氟胞嘧啶治疗,总有效率78.5%,42例患者治愈9例,好转24例,死亡5例,自动出院后失访4例。结论:隐球菌脑膜炎由于临床表现、脑脊液常规和生化检查以及影像学检查无明显特异性,易于误诊;脑脊液墨汁染色有助于早期诊断本病,对疑似病例反复进行脑脊液墨汁染色有利于确诊;两性霉素B联合5-氟胞嘧啶治疗治疗隐球菌脑膜炎效果良好。但需注重合理应用并密切监测不良反应。
Objective: To summarize and analyze the incidence of 42 cases of cryptococcal meningitis, clinical features and experience of treatment of antifungal agents to improve the diagnosis and treatment of cryptococcal meningitis. Methods: The clinical manifestations, laboratory findings, antifungal efficacy and prognosis of 42 cases of cryptococcal meningitis in West China Hospital of Sichuan University from 2001 to 2007 were retrospectively analyzed. The effects of amphotericin B combined with 5-fluorocytosine Anti-fungal drug dose, efficacy, adverse reactions and the relationship between treatment and prognosis to be analyzed. Results: The clinical manifestations of fever, headache, increased intracranial pressure and meningeal irritation were amphotericin B combined with 5-fluorocytosine, with a total effective rate of 78.5%, 42 patients were cured in 9 cases and 24 cases were improved , 5 died, 4 cases were lost to automatic discharge. Conclusion: Cryptococcal meningitis is not easy to be misdiagnosed due to clinical manifestations, cerebrospinal fluid routine and biochemical examination and imaging examination. Cerebrospinal fluid ink stain is helpful to diagnose the disease early. Recurrent cerebrospinal fluid ink stain is helpful for the suspected cases. Amphotericin B combined with 5-fluorocytosine treatment of cryptococcal meningitis with good results. However, attention should be paid to the rational application and close monitoring of adverse reactions.