摘要
目的观察糖皮质激素(激素)联合脑脊液引流术、抗真菌治疗伴颅内高压艾滋病相关隐球菌脑膜炎的临床疗效。方法选择50例伴颅内高压的艾滋病相关隐球菌脑膜炎患者,按意愿分为观察组和对照组,每组各25例患者,对照组采取抗真菌治疗及脑脊液引流术,观察组在对照组基础上加用激素治疗。比较2组治疗后的症状改善、脑脊液隐球菌转阴情况及脑脊液细胞学检查结果。结果 2组患者的临床疗效比较差异无统计学意义(P> 0.05)。治疗后,2组患者的临床症状均有改善,其中观察组患者的发热、头痛、恶心呕吐、抽搐等发生率均低于对照组(P均<0.05)。观察组脑脊液隐球菌转阴率高于对照组,脑脊液隐球菌转阴时间短于对照组(P均<0.05)。治疗后,2组患者的脑脊液压力、白细胞、蛋白水平均比治疗前降低(P均<0.05),糖、氯化物水平均比治疗前升高(P均<0.05),且观察组的脑脊液压力、白细胞、蛋白水平均低于对照组(P均<0.05),糖、氯化物水平均高于对照组(P均<0.05)。治疗过程中,2组患者均出现不同程度低血钾、血小板减少、肝损伤等,但症状均较轻微,患者可耐受,无需终止治疗。2组均无死亡病例。结论对于伴颅内高压的艾滋病相关隐球菌脑膜炎患者,采用激素联合脑脊液引流术、抗真菌治疗能够改善患者的临床症状及颅内高压,促进脑脊液隐球菌转阴,减轻脑脊液细胞学损伤,疗效良好。
Objective To observe the clinical efficacy of glucocorticoids combined with cerebrospinal fluid drainage and antifungal therapy in the treatment of AIDS-related cryptococcal meningitis complicated with persistent intracranial hypertension. Methods Fifty patients with AIDS-related cryptococcal meningitis complicated with intracranial hypertension were selected and divided into the control (n=25) and the observation groups (n=25) according to their willingness. In the control group, antifungal therapy and cerebrospinal fluid drainage were adopted, and antifungal therapy and cerebrospinal fluid drainage in combination with glucocorticoids were delivered in the observation group. The relief of clinical symptoms, negative rate of cerebrospinal fluid cryptococcus and changes in the cytological examination of cerebrospinal fluid were statistically compared between two groups after corresponding treatment. Results The clinical efficacy did not significantly differ between two groups( P > 0.05). After corresponding treatment, clinical symptoms were alleviated in two groups. The incidence rate of fever, headache, nausea, vomiting and convulsions in the observation group was significantly lower than that in the control group( all P < 0.05). In the observation group, the negative rate of cryptococcus in the cerebrospinal fluid was significantly higher and the time from positive to negative cryptococcus was significantly shorter than those in the control group( both P < 0.05). After corresponding treatment, the cerebrospinal fluid pressure, white blood cell count and protein level were significantly reduced, whereas the levels of glucose and chloride were significantly increased in two groups( all P < 0.05). Compared with the control group, the cerebrospinal fluid pressure, white blood cell count and protein level were significantly lower, whereas the levels of glucose and chloride were considerably higher in the observation groups (all P < 0.05). Throughout the treatment, patients in both groups presented with slight hypokal
作者
邓星海
许飞龙
刘新华
宋清宇
徐晓鹏
Deng Xinghai;Xu Feilong;Liu Xinhua;Song Qingyu;Xu Xiaopeng(Department of Neurosurgery, Guangzhou Eighth People’s Hospital Affiliated to Guangzhou Medical University, Guangzhou 510060, China)
出处
《新医学》
2019年第3期206-210,共5页
Journal of New Medicine
关键词
艾滋病
隐球菌脑膜炎
颅内高压
脑脊液引流术
糖皮质激素
AIDS
Cryptococcal meningitis
Intracranial hypertension
Cerebrospinal fluid drainage
Glucocorticoid
