新型隐球菌性脑膜炎与结核性脑膜炎的临床鉴别

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/1h、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。

The differential diagnosis of cryptococcal meningitis and tuberculous meningitis

Objective To investigate the differential diagnosis of cryptococcal meningitis（CM） and tuberculous meningitis（TBM）.Method We analyzed retrospectively the clinical data of clinical manifestation,cerebrospinal fluid（CSF） and head CT or MRI in 19 cases with cryptococcal meningitis and in 50 cases with tuberculous meningitis.Results There were significant differences in delayed diagnostic time,complications,cranial nerve damage,intracranial pressure and glucose value of CSF,positive rate of polymerase chain reaction for TB（PCR-TB）,positive rate of lipoarabinomannan antibody（LAM-Ab） in serum and CSF,erythrocyte sedimentation rate（ESR）,the detect rate of abnormal imaging in head CT or MRI between TBM and CM.However,there were not significant differences in clinical manifestation,white cell count in CSF,protein value,chloride value,adenosine deaminase（ADA） value,head CT or MRI imaging between TBM and CM.Conclusions The clinical characteris ＇ tics of CM are atypical.It is difficult to be differentiated with TBM and be misdiagnosed easily.Multiple markers combination is useful to diagnose CM earlier.