摘要
目的 探讨非艾滋病（AIDS）相关隐球菌性脑膜炎合并脑神经损伤患者的危险因素及预后因素.方法 回顾性分析非AIDS相关隐球菌性脑膜炎115例患者的临床资料,记录其临床特征、治疗及预后情况,采用Logistic逐步回归法对危险因素和预后因素进行分析.结果 115例患者脑神经损伤发生率为35.7％（41/115）,其中视神经、动眼神经、听神经、外展神经、嗅神经和面神经受累比例分别为48.8％ （20/41）、39.0％（16/41）、24.4％（10/41）、12.2％ （5/41）、7.3％ （3/41）、4.9％（2/41）.预测脑神经损伤的危险因素是确诊时间延长（OR=1.057,95％ CI 1.003～ 1.112）,同时脑脊液有核细胞数降低及颅内压增高也是发生脑神经损伤的独立预测因素（P＜0.05）.72.2％ （26/36）发生脑神经损伤患者可以完全恢复,恢复时间为0.5～24.0（3.8±1.7）个月.脑神经损伤恢复的独立预测因素是脑神经受累数量（OR=0.241,95％ CI0.067～0.801,P=0.023）及采用联合治疗方案（OR=10.328,95％CI 2.087～51.026,P=0.006）.结论 脑神经损伤在非AIDS相关隐球菌性脑膜炎中比较常见,确诊时间延长、颅内压增高以及脑脊液有核细胞数降低与其发生率相关,而脑神经受累数量和采用联合治疗方案是脑神经恢复的独立预测因素;早期诊断加积极有效抗真菌治疗对防治脑神经损伤至关更要.
Objective To explore the risk and prognosis factor of cranial nerve injury in non acquired immune deficiency syndrome（AIDS）-related cryptococcal meningitis.Methods The clinical data of 115 patients with non-AIDS-related cryptococcal meningitis were reviewed retrospectively.Clinical characteristics,initial antifungal therapies and outcome of these patients were analyzed.The risk and prognosis factor was performed by multivariate Logistic regression.Results The incidence of cranial nerve injury was 35.7％（41/115）.Among of them,the involved ratio was 48.8％ （20/41）,39.0％ （16/41）,24.4％ （10/41）,12.2％ （5/41）,7.3％ （3/41）,4.9％ （2/41） in optic nerve,oculomotor nerve,acoustic nerve,abducent nerve,olfactory nerve,facial nerve.Predictive risk factor for cranial nerve injury was duration of diagnosis （OR =1.057,95％ CI 1.003-1.112）,low cerebrospinal fluid cell count and intracranial hypertension were also the independent predictive factors （both P ＜ 0.05）.In the follow-up peried,72.2％ （26/36） patients who had cranial nerve injury were fully recovered,with a median time of 0.5-24.0 （3.8 ±1.7） months.The independent predictors of recovery were numbers of nerve involved （OR =0.241,95 ％ CI 0.067-0.801,P =0.023） and combination therapy （OR =10.328,95 ％ CI 2.087-51.026,P =0.006）.Condusions Cranial nerve injury is common in non-AIDS-related cryptococcal meningitis.Delay in diagnosis,intracranial hypertension and low cerebrospinal fluid cell count are independent predictive factors.Less cranial nerve involvement and combination therapy predicts recovery.
出处
《中国医师进修杂志》
2014年第8期17-20,共4页
Chinese Journal of Postgraduates of Medicine
关键词
脑膜炎
隐球菌性
脑神经损伤
两性霉素B
三唑类
预后
Meningitis,cryptococcal
Cranial nerve injuries
Amphotericin B
Triazoles
Prognosis
