14例新型隐球菌性脑膜炎临床分析

目的分析新型隐球菌性脑膜炎的临床特点、治疗及转归。方法对14例患者的临床资料进行回顾性分析并文献复习。结果 14例患者均经病原学确诊。单用两性霉素B脂质体（amphotericinB,AmpB）治疗2例,两性霉素B脂质体＋氟康唑（fluconazole,FCZ）治疗5例,两性霉素B脂质体＋氟康唑＋5-氟胞嘧啶（5-flucytosine,5-FU）治疗2例,两性霉素B脂质体＋5-Fu治疗2例,两性霉素B脂质体＋氟康唑＋鞘内注射治疗1例,两性霉素B脂质体＋氟康唑＋5-Fu＋鞘内注射治疗2例。脑脊液真菌转阴后,改用氟康唑（fluconazole,FCZ）口服巩固维持治疗。治愈3例,好转3例,死亡1例（死于脑疝）,余7例自动出院。结论联合用药治疗新型隐球菌性脑膜炎效果较好,改善预后。

Clinical analysis of 14 cases of cryptococcus neoformans meningitis

Objective To analyze the clinical characters、treatments and prognosis of cryptococcus neoformans meningitis(CNM).Methods We retrospectively analyzed the clinical data of 14 patients with cryptococcal neoformans meningitis.The relevant medical literature was reviewed.Results The diagnosis of cryptococcus neoformans meningitis was established in 14 cases by the present of cryptococcus.Two patients were treated with amphotericin B,5 patients were given amphotericin B combination with fluconazole,Two patients were treated with amphotericin B combination with fluconazole and 5-flucytosine,Two patients were treated with amphotericin B combination with 5-flucytosine,2 patients were given amphotericin B combination with fluconazole,5-flucytosine,Intrathecal injection of amphotericin B and dexamethone,1 patients were given amphotericin B combination with fluconazole,and Intrathecal injection of amphotericin B and dexamethong,After their condition improved and cerebral fluid pathogeny test became negative,all patients received oral FCZ for maintain therapy.The outcome of the 14 cases showed that 3 patients were cured,3 improved.1 died and 7 gave up any further treatment.Conclusion Combination of antifungal therapy could achieve better effect in treatment of CNM.