新型隐球菌脑膜炎发病相关因素的回顾性巢式病例对照研究

目的 探讨急性脑炎、脑膜炎人群中发生新型隐球菌脑膜炎的危险因素。方法 采用1∶4匹配的回顾性巢式病例对照研究方法寻找脑炎、脑膜炎人群发生新型隐球菌脑膜炎的危险因素,使用条件Logistic回归进行分析。结果 在1 037例急性脑炎、脑膜炎病例中,真菌培养确诊新型隐球菌脑膜炎23例,累计发病率、发病密度分别为2.22%、10.50人年。78.26%(18例)的病例是15岁以下儿童。多因素条件Logistic回归分析发现发病至就诊的间隔时间在20 d以上(OR=28.78)、曾暴露于鸽子等鸟类及其粪便、植物和土壤(OR=20.49)、患者或其家长大专及以上学历(OR=0.10)、伴有其他基础疾病(OR=8.85)是该病的相关因素。结论 发病至就诊的间隔时间在20 d以上,曾暴露于鸽子等鸟类及其粪便、植物和土壤等腐生物质,伴有其他基础疾病是该病的危险因素;患者或其家长大专及以上学历是其保护因素。

A nested case-control study on the influencing factors of Cryptococcus neoformans meningitis in patientswith acute meningitis and encephalitis

A 1: 4 matched retrospective nested case control study was conducted in a cohort of 1 037 patients with acute meningitis and encephalitis to analyze the risk factors of Cryptococcus neoformans meningitis. The conditional logistic regression was used for data analysis. Results indicated that 23 cases were confirmed as Cryptococcus neoformans meningitis among 1 037 cases with acute meningitis and encephalitis using the culture. The cumulative incidence rate was 2.22%. The cumulative incidence density was 10.50 person years. The median age was 12 years and 78.26% of patients <15 years. In multivariate conditional logistic regression analysis, interval time from illness onset to admission (OR=28.78), exposure history to birds (eg. pigeon) and/or their feces, or saprophytes (eg. plants or soil) (OR=20.49), education level (OR=0.10) and underlying disease (OR=8.85) were all associated independently with the increased risk for the incidence of Cryptococcus neoformans meningitis. Patients or their parents with well education may be the protective factor.