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目的探讨新型隐球菌性脑膜炎与结核性脑膜炎的鉴别要点。方法回顾分析19例隐球菌性脑膜炎及50例结核性脑膜炎患者的临床表现、脑脊液改变和头颅CT或MRI特点。结果隐球菌性脑膜炎延误诊断时间为(2.3±1.7)个月,合并颅外结核病26.3%,合并慢性基础病36.8%,颅神经损害发生率5.3%,颅内压(320.0±57.7)mmH2O,脑脊液葡萄糖含量(1.2±0.8)mmol/L,PCR-TB阳性率0%,抗结核抗体阳性率10.5%,红细胞沉降率(42.1±31.2)mm/1 h、头颅CT或MRI检查阳性发现率57.9%等方面与结核性脑膜炎存在差异。而2者在临床症状、脑脊液白细胞数、蛋白、氯化物、腺苷脱氨酶含量和头颅CT或MRI表现等方面差异无统计学意义。结论隐球菌性脑膜炎临床表现不典型,与结脑不易鉴别,容易误诊。但提高对隐球菌性脑膜炎的认识,并行多项指标检测有利于早期诊断。
Objective To explore the main points of differential diagnosis between Cryptococcus neoformans meningitis and tuberculous meningitis. Methods Retrospective analysis of 19 cases of cryptococcal meningitis and 50 cases of tuberculous meningitis in patients with clinical manifestations, cerebrospinal fluid changes and CT or MRI features. Results The diagnosis of cryptococcal meningitis was delayed for 2.3 ± 1.7 months with 26.3% of patients with extracranial tuberculosis, 36.8% of patients with chronic basis disease, 5.3% of cranial nerve injury, 320.0 ± 57.7 mmH2O of intracranial pressure, Cerebrospinal fluid glucose content (1.2 ± 0.8) mmol / L, PCR-TB positive rate of 0%, anti-TB antibody positive rate of 10.5%, erythrocyte sedimentation rate (42.1 ± 31.2) mm / 1 h, cranial CT or MRI positive detection rate of 57.9 % And other aspects of tuberculous meningitis there are differences. However, there was no significant difference in clinical symptoms, leukocyte count, protein, chloride, adenosine deaminase content, cranial CT or MRI findings between the two groups. Conclusion The clinical manifestations of cryptococcal meningitis are not typical, and difficult to identify with knot brain, easily misdiagnosed. However, to improve understanding of cryptococcal meningitis, parallel detection of multiple indicators conducive to early diagnosis.