中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
8期
17-20
,共4页
脑膜炎,隐球菌性%脑神经损伤%两性霉素B%三唑类%预后
腦膜炎,隱毬菌性%腦神經損傷%兩性黴素B%三唑類%預後
뇌막염,은구균성%뇌신경손상%량성매소B%삼서류%예후
Meningitis,cryptococcal%Cranial nerve injuries%Amphotericin B%Triazoles%Prognosis
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.
目的 探討非艾滋病(AIDS)相關隱毬菌性腦膜炎閤併腦神經損傷患者的危險因素及預後因素.方法 迴顧性分析非AIDS相關隱毬菌性腦膜炎115例患者的臨床資料,記錄其臨床特徵、治療及預後情況,採用Logistic逐步迴歸法對危險因素和預後因素進行分析.結果 115例患者腦神經損傷髮生率為35.7％(41/115),其中視神經、動眼神經、聽神經、外展神經、嗅神經和麵神經受纍比例分彆為48.8％ (20/41)、39.0％(16/41)、24.4％(10/41)、12.2％ (5/41)、7.3％ (3/41)、4.9％(2/41).預測腦神經損傷的危險因素是確診時間延長(OR=1.057,95％ CI 1.003～ 1.112),同時腦脊液有覈細胞數降低及顱內壓增高也是髮生腦神經損傷的獨立預測因素(P＜0.05).72.2％ (26/36)髮生腦神經損傷患者可以完全恢複,恢複時間為0.5～24.0(3.8±1.7)箇月.腦神經損傷恢複的獨立預測因素是腦神經受纍數量(OR=0.241,95％ CI0.067～0.801,P=0.023)及採用聯閤治療方案(OR=10.328,95％CI 2.087～51.026,P=0.006).結論 腦神經損傷在非AIDS相關隱毬菌性腦膜炎中比較常見,確診時間延長、顱內壓增高以及腦脊液有覈細胞數降低與其髮生率相關,而腦神經受纍數量和採用聯閤治療方案是腦神經恢複的獨立預測因素;早期診斷加積極有效抗真菌治療對防治腦神經損傷至關更要.
목적 탐토비애자병(AIDS)상관은구균성뇌막염합병뇌신경손상환자적위험인소급예후인소.방법 회고성분석비AIDS상관은구균성뇌막염115례환자적림상자료,기록기림상특정、치료급예후정황,채용Logistic축보회귀법대위험인소화예후인소진행분석.결과 115례환자뇌신경손상발생솔위35.7％(41/115),기중시신경、동안신경、은신경、외전신경、후신경화면신경수루비례분별위48.8％ (20/41)、39.0％(16/41)、24.4％(10/41)、12.2％ (5/41)、7.3％ (3/41)、4.9％(2/41).예측뇌신경손상적위험인소시학진시간연장(OR=1.057,95％ CI 1.003～ 1.112),동시뇌척액유핵세포수강저급로내압증고야시발생뇌신경손상적독립예측인소(P＜0.05).72.2％ (26/36)발생뇌신경손상환자가이완전회복,회복시간위0.5～24.0(3.8±1.7)개월.뇌신경손상회복적독립예측인소시뇌신경수루수량(OR=0.241,95％ CI0.067～0.801,P=0.023)급채용연합치료방안(OR=10.328,95％CI 2.087～51.026,P=0.006).결론 뇌신경손상재비AIDS상관은구균성뇌막염중비교상견,학진시간연장、로내압증고이급뇌척액유핵세포수강저여기발생솔상관,이뇌신경수루수량화채용연합치료방안시뇌신경회복적독립예측인소;조기진단가적겁유효항진균치료대방치뇌신경손상지관경요.
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.
