| 新型隐球菌性脑膜炎与结核性脑膜炎的诊断与鉴别诊断 |
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| 引用本文： | 程耀,黄涛,陈洪德,吴桂辉. 新型隐球菌性脑膜炎与结核性脑膜炎的诊断与鉴别诊断[J]. 中国防痨杂志, 2019, 41(1): 48-52. DOI: 10.3969/j.issn.1000-6621.2019.01.011 |
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| 作者姓名： | 程耀 黄涛 陈洪德 吴桂辉 |
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| 作者单位： | 610061.成都市公共卫生临床医疗中心结核科 |
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| 基金项目： | 成都市科技惠民项目(2015-HM01-00479-SF) |
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| 摘 要： | 目的 总结分析新型隐球菌性脑膜炎(CNM)与结核性脑膜炎(TBM)的临床特点,以提高CNM与TBM诊断与鉴别诊断水平。方法 搜集2016年1月至2017年12月成都市公共卫生临床医疗中心收治的CNM患者32例(CNM组)及同期收治的TBM患者171例(TBM组),对两组患者的一般资料(年龄、性别、生活区域、是否并发免疫功能低下)、临床症状(头痛、发热、呕吐、呼吸道症状、抽搐、脑膜刺激征及病理征)、脑脊液(CSF)实验室检查指标(CSF压力、细胞数、淋巴细胞百分比、蛋白、葡萄糖)、头颅CT检查(正常、脑水肿、脑积液、脑实质结节样改变、多发软化灶)情况进行对比分析。结果 TBM组患者年龄为(39.23±12.77)岁,高于CNM组患者[(28.71±11.29)岁],差异有统计学意义(t=4.35,P=0.000);TBM组患者呼吸道症状、抽搐、头颅CT检查提示脑实质结节样改变及多发软化灶发生率分别为94.74%(162/171)、35.09%(60/171)、41.52%(71/171)、38.01%(65/171),均明显高于CNM组患者[分别为34.38%(11/32)、15.62%(5/32)、6.25%(2/32)、9.38%(3/32)],差异均有统计学意义(χ 2值分别为73.26、4.69、13.07、8.68,P值分别为0.000、0.030、0.000、0.003);CNM组患者免疫功能低下(包括并发HIV感染、尿糖病,接受器官移植,长期口服糖皮质激素或免疫抑制剂等)和头颅CT检查提示脑水肿改变发生率分别为34.38%(11/32)、46.88%(15/32),均高于TBM组患者[分别为18.13%(31/171)、25.15%(43/171)],差异均有统计学意义(χ 2值分别为4.34、6.24,P值分别为0.037、0.013);CSF实验室检查中,TBM组患者CSF细胞数[中位数(M)(四分位数;Q1,Q3)]、蛋白[M(Q1,Q3)]、葡萄糖含量分别为208.00(178.00,240.00)×10 6/L、1058.00(940.00,1204.00)mg/L、(1.77±0.79)mmol/L,均明显高于CNM组患者[分别为64.50(51.00,81.00)×10 6/L、764.00(608.00,894.50)mg/L、(0.25±0.17)mmol/L],差异均有统计学意义(Z=-76.77,P=0.000;Z=-6.83,P=0.000;t=10.82,P=0.000);CNM组患者CSF压力为[(273.42±71.58)mm H2O(1mm H2O=0.098kPa)],明显高于TBM组患者[(214.22±88.38)mm H2O],差异有统计学意义(t=3.57,P=0.000)。结论 CNM患者并发免疫功能低下和头颅CT提示脑水肿改变的比率高于TBM患者,而在呼吸道及抽搐症状的发生、头颅CT提示脑实质结节样改变、多发软化灶等发生的比率均低于TBM患者。
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| 关 键 词： | 结核 脑膜 脑膜炎 隐球菌性 诊断 鉴别 疾病特征 病例对照研究 |
| 收稿时间： | 2018-11-01 |
Diagnosis and differential diagnosis of cryptococcus neoformans meningitis and tuberculous meningitis |
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| Yao CHENG,Tao HUANG,Hong-de CHEN,Gui-hui WU. Diagnosis and differential diagnosis of cryptococcus neoformans meningitis and tuberculous meningitis[J]. The Journal of The Chinese Antituberculosis Association, 2019, 41(1): 48-52. DOI: 10.3969/j.issn.1000-6621.2019.01.011 |
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| Authors: | Yao CHENG Tao HUANG Hong-de CHEN Gui-hui WU |
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| Affiliation: | Tuberculosis Inpatient of Chengdu Municipal Public Health Clinical Medical Center, Chengdu 610061, China |
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| Abstract: | Objective To summarize and analyze the clinical features of cryptococcus neoformans meningitis (CNM) and tuberculous meningitis (TBM), and to improve the diagnosis and differential diagnosis of CNM and TBM. Methods From January 2016 to December 2017, 32 CNM patients and 171 TBM patients who admitted to Chengdu Municipal Public Health Clinical Medical Center were included in this study. General information (including age, gender, living area, and whether complicated with low immune function or not), clinical symptoms (including headache, fever, vomiting, respiratory symptoms, convulsions, meningeal irritation, and pathology), cerebrospinal fluid (CSF) laboratory test indicators (including CSF pressure, cell number, lymphocyte proportion, protein level, and glucose content), and CT scan results (normal, cerebral edema, hydrocephalus, brain parenchymal nodular changes, and multiple softening lesions) were compared between CNM and TBM patients.Results The age of patients with TBM was (39.23±12.77) years old, greater than that of CNM patients ((28.71±11.29) years old), and the difference was statistically significant (t=4.35, P=0.000). The occurrence rate of respiratory symptoms, convulsions, change in brain parenchymal nodules, and multiple softening lesions indicated by cranial CT scan in patients with TBM were 94.74% (162/171), 35.09% (60/171), 41.52% (71/171), and 38.01% (65/171), which were significantly higher those in CNM patients (34.38% (11/32), 15.62% (5/32), 6.25% (2/32), and 9.38% (3/32)), and the differences were statistically significant (χ 2 values were 73.26, 4.69, 13.07, and 8.68; P values were 0.000, 0.030, 0.000, and 0.003). The rate of low immune function (including complication with HIV infection, urinary glucose disease, organ transplantation, long-term oral glucocorticoids or immunosuppressive agents) and cerebral edema indicted by cranial CT scan in CNM patients were 34.38% (11/32) and 46.88% (15/32), respectively, which were higher than those in TBM patients (18.13% (31/171) and 25.15% (43/171)); the differences were statistically significant (χ 2 values were 4.34 and 6.24; P values were 0.037 and 0.013). Regarding the CSF laboratory examination, the number of CSF cells, protein level (median (quartile, Q1, Q3)), and glucose content in the TBM patients were 208.00 (178.00, 240.00)×10 6/L, 1058.00 (940.00, 1204.00) mg/L, and (1.77±0.79) mmol/L, respectively, which were significantly higher than those in patients with CNM (64.50 (51.00, 81.00)×10 6/L, 764.00 (608.00, 894.50) mg/L, and (0.25±0.17) mmol/L); the differences were statistically significant (Z=-76.77, P=0.000; Z=-6.83, P=0.000; t=10.82, P=0.000). The CSF pressure of CNM patients was ((273.42±71.58 mm H2O) (1mm H2O=0.098 kPa)), which was signi-ficantly higher than that of TBM patients (214.22±88.38 mm H2O). The difference was statistically significant (t=3.57, P=0.000). Conclusion Compared with TBM patients, CNM patients have higher occurrence rates of complication with low immune function and cerebral edema indicated by cranial CT scan, but lower occurrence rate of respiratory symptoms and convulsions, as well as parenchymal nodule changes and multiple softening lesions indicated by cranial CT scan. |
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| Keywords: | Tuberculosis meningeal Meningitis cryptococcal Diagnosis differential Disease attri-butes Case-control studies |
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