病原治疗前脑脊液隐球菌负荷量在新生隐球菌性脑膜炎临床转归中的意义

目的:探讨新生隐球菌性脑膜炎患者病原治疗前脑脊液隐球菌负荷量与治疗效果及临床转归的关系.方法:收集52例新生隐球菌性脑膜炎患者的临床资料,以治疗前脑脊液隐球菌计数与临床转归关系的特异度及灵敏度之和的最大值所对应的脑脊液隐球菌计数2 125个/ml为分界点,分为脑脊液隐球菌计数＜2 125个/ml(低量)组31例和脑脊液隐球菌计数≥2 125个/ml(高量)组21例,比较抗真菌治疗后两组患者的阴转率和临床疗效.结果:抗真菌治疗后低量组的脑脊液隐球菌阴转率为52％,高量组的脑脊液隐球菌阴转率为14％,两组比较差异有统计学意义(P＜0.01)；低量组治愈率48％,好转率23％,总有效率71％:高量组治愈率14％,好转率14％,总有效率29％,两组的治愈率及总有效率比较差异均有统计学意义(P＜0.01).结论:在新生隐球菌性脑膜炎患者中,病原治疗前脑脊液隐球菌计数＜2 125个/ml者相比于≥2125个/ml者,抗真菌治疗后脑脊液隐球菌阴转率高,临床转归好,脑脊液隐球菌负荷量是评估治疗效果和临床转归的一个实用、便捷的参数.

The significance of cryptococcal load in cerebrospinal fluid before etiological treatment in clinical outcome of patients with Cryptococcus neoformans meningitis

Objective： To investigate the relationship between cryptococcal load in cerebrospinal fluid before etiological therapy and therapeutic effect, clinical outcome in patients with Cryptococcus neoformans meningitis. Methods： Clinical data from 52 patients with Cryptococcus neoformans meningitis were collected. The point of 2 125/ml of cryptococcal counting in cerebrospinal fluid was set as the dividing point, which was corresponding with the maximum of the sum of specificity a.nd sensitivity of the relationship between Cryptococcus load before treatment and clinical outcome. Patients were divided into low quantity group （cryptococcal counting in CSF 〈 2 125/ ml） and high quantity group （cryptococcal counting in CSF ≥2 125/ml）. Clinical data including therapeutic effect and clinical outcome were compared after antifungal treatment. Results： The negative conversion rate of Cryptococcus in CSF after ontifungal treatment was 52% in low quantity group, and 14% in high quantity group, respectively, with statistical significance （P 〈0. 01 ）. Cure rate, improvement rate and total effective rate were respectively 48%, 23%, 71% in low quantity group, and 14%, tical significance （ P 〈 0. 01 ）. Conclusions： The 14%, 29% in high quantity group, respectively, with statisnegative conversion rate of CSF Cryptococcus after antifungal treatment is higher and the clinical outcome is better in Cryptococcus neoformans meningitis patients with low quantity load than with high quantity load. Cryptococcal load in CSF is a practical and convenient parameter in evaluating therapeutic effect and clinical outcome.