隐球菌脑膜炎42例临床分析 |
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引用本文: | 刘发彬,;周小茜,;刘凯,;吕晓菊. 隐球菌脑膜炎42例临床分析[J]. 华西医学, 2009, 0(5): 1157-1159 |
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作者姓名: | 刘发彬, 周小茜, 刘凯, 吕晓菊 |
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作者单位: | [1]四川大学华西医院感染性疾病中心; [2]内江市第一人民医院感染科,四川成都610041 |
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摘 要: | 目的:归纳分析42例隐球菌脑膜炎的发病情况、临床特点并总结抗真菌药物的治疗经验,以提高对隐球菌脑膜炎的诊治水平。方法:回顾分析四川大学华西医院2001~2007年所收治42例隐球菌脑膜炎病例的临床表现、实验室检查结果、抗真菌药物的疗效及预后,并对两性霉素B联合5-氟胞嘧啶抗真菌治疗的药物剂量、疗效、不良反应以及疗程与预后的关系加以剖析。结果:临床以发热、头痛、颅内压升高、脑膜刺激征为主要表现,采用两性霉素B联合5-氟胞嘧啶治疗,总有效率78.5%,42例患者治愈9例,好转24例,死亡5例,自动出院后失访4例。结论:隐球菌脑膜炎由于临床表现、脑脊液常规和生化检查以及影像学检查无明显特异性,易于误诊;脑脊液墨汁染色有助于早期诊断本病,对疑似病例反复进行脑脊液墨汁染色有利于确诊;两性霉素B联合5-氟胞嘧啶治疗治疗隐球菌脑膜炎效果良好。但需注重合理应用并密切监测不良反应。
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关 键 词: | 隐球菌 脑膜炎 诊断 治疗 |
Clinical Analysis of 42 Patients with Cryptococcal Meningitis |
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Affiliation: | LIU Fa-bin, ZHOU Xiao-qian, LIU Kai, et al. (1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China; 2. Department of Communicable Diseases, First Municipal People's Hospital of Neijiang City, Neijiang Sichuan 641000, China) |
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Abstract: | Objective: To improve the management level of Cryptocaccal meningitis by analyzing clinical data of 42 patients. Methods: Retrospectively studied clinical manifestation, auxiliry examinations, misdiagnosis and therapy based on 42 patients with Cryptococcal meningitis in West China Hospital. Results: The main clinical manifestation included fever, headache, intracranial hypertension and signs of meningeal irritation. The total effective rate was 78. 5% by Amphotericin B monotherapy or combined with 5-fluorocytosine. In general, 9 cases were cured, 24 were improved, 5 died and 4 gave up any further treatment. Conclusion: Cryptococcal meningitis is easily misdiagnosed due to its non-specific clinical manifestations in early stage. Detection of cerebrospinal fluid is frequently crucial for preventing misdiagnosis. Combination therapy using Amphotericin B with 5-fluorocytosine is effective and well tolerable. |
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Keywords: | cryptococcus meningitis diagnosis therapy |
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