CAJ | 학술논문

目的了解中枢神经系统少见真菌感染的临床特点.方法收集1997年至2010年复旦大学附属华山医院收治的中枢神经系统少见真菌感染病例,共35例,对其病原菌种类、临床特点、疗效等进行回顾性分析,统计学方法采用秩和检验和Fisher确切概率法.结果 35例患者中确诊29例,临床诊断6例.30例患者存在一种或多种易感因素,占86%,致病菌主要有曲霉感染16例,念珠菌感染14例.常见的临床表现有发热22例.头痛19例,脑神经受累12例,脑膜刺激征12例.脑脊液变化为WBC增多、蛋白含量升高及糖含量降低.其中曲霉感染患者多存在免疫力低下的基础疾病,常由邻近部位感染或血流播散所致,以头痛和脑神经受累等脑实质损害为主;而念珠菌感染患者多继发于颅脑手术或外伤后,以发热、脑膜刺激征以及脑脊液异常等脑膜炎表现为主.总有效率为77%(27/35),其中曲霉感染患者以颅内病灶手术清除联合抗真菌药物疗效较佳;念珠菌感染由于多继发于颅脑手术.尤其是脑脊液外引流术,抗真菌药物治疗同时更换或拔除引流管可达到较好疗效.结论近年来曲霉、念珠菌等中枢神经系统少见真菌感染有明显增多趋势,而早期诊断和及时治疗是改善预后的关键.
목적 료해중추신경계통소견진균감염적림상특점.방법 수집1997년지2010년복단대학부속화산의원수치적중추신경계통소견진균감염병례,공35례,대기병원균충류、림상특점、료효등진행회고성분석,통계학방법채용질화검험화Fisher학절개솔법.결과 35례환자중학진29례,림상진단6례.30례환자존재일충혹다충역감인소,점86%,치병균주요유곡매감염16례,념주균감염14례.상견적림상표현유발열22례.두통19례,뇌신경수루12례,뇌막자격정12례.뇌척액변화위WBC증다、단백함량승고급당함량강저.기중곡매감염환자다존재면역력저하적기출질병,상유린근부위감염혹혈류파산소치,이두통화뇌신경수루등뇌실질손해위주;이념주균감염환자다계발우로뇌수술혹외상후,이발열、뇌막자격정이급뇌척액이상등뇌막염표현위주.총유효솔위77%(27/35),기중곡매감염환자이로내병조수술청제연합항진균약물료효교가;념주균감염유우다계발우로뇌수술.우기시뇌척액외인류술,항진균약물치료동시경환혹발제인류관가체도교호료효.결론 근년래곡매、념주균등중추신경계통소견진균감염유명현증다추세,이조기진단화급시치료시개선예후적관건.
Objective To analyze the clinical features of patients with uncommon fungal infections in central nervous system (CNS).Methods Thirty-five patients with uncommon CNS fungal infections who were admitted to Huashan Hospital from 1997 to 2010 were retrospectively reviewed.The pathogens,symptoms and signs.treatments of patients were evaluated.The data were analyzed by rank sum test and Fisher'S exact test.Results Twenty-nine of the 35 patients met the definition criteria of prover CNS fungal infections,while the other 6 had probable diagnosis.Predisposing factors were found in 86% of all patients.The most common pathogens were Aspergillus and Candida species.The symptoms and signs commonly occurred including fever(22 cases),headache(19 cases), cranial neuropathy(12 cases),and meningeal irritation sign(12 cases).High white blood cell count,high protein level,and low glucose level were the main findings of cerebrospinal fluid (CSF) analysis.Patients with cerebral aspergillosis were more frequently accompanied with immunocompromised conditions, and they often got CNS aspergillosis from hematogenous dissemination or direct extension of paranasal sinus infection.Cerebral granuloma and abscess were the common clinical characteristics of CNS aspergillosis.Cerebral candidiasis often arose from neurosurgical surgery or traumatic brain injury,and these patients were usually presented with meningitis.All patients were treated with antifungal drugs and (or) surgical intervention and 77%(27/35) of the patients achieved complete or partial responses. Antifungal agents combined with surgical resection might improve outcome of patients with CNS aspergillosis; while removal or replacement of drainage tubes in combination with antifungal treatment showed satisfactory efficacy in patients with cerebral candidiasis who usually had shunt manipulation. Conclusions The incidence of CNS fungal infection, such as cerebral aspergillosis and candidiasis, is increasing. Early diagnose and therapeutic intervention are crucial for improving outcome.