CAJ | 학술논문

目的了解非AIDS相关隐球菌性脑膜炎患者并发颅神经损伤的危险因素及预后因素.方法回顾性分析复旦大学附属华山医院2000年1月至2010年12月住院治疗的隐球菌性脑膜炎145例,总结临床特征、抗真菌治疗和恢复情况.采用多因素分析法对相关危险因素和预后因素进行研究.连续变量采用f检验,离散变量采用x2检验或Fisher确切概率检验.结果 145例患者中52例出现颅神经损伤,发生率为35.9％,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分别为25、22、12、6、4、3例,分别占所有颅神经损伤患者的48.1％、42.3％、23.1％、11.5％、7.7％和5.8％.确诊时间是发生颅神经损伤的最强危险因素(OR=1.056,95％ CI为1.002～1.111),诊断时间每延长1周,颅神经损伤发生率就增加5.6％.颅内压高及脑脊液有核细胞数降低也是发生颅神经损伤的独立预测因素(均P＜0.05).发生颅神经损伤后有73.3％患者可以完全恢复,恢复中位时间为3个月(0.5～24.0个月).受累神经数量(OR=0.230,95％CI为0.066～0.800,P=0.021)和两性霉素B联合三唑类药物治疗(AmB+ 5-FC+三唑类药物)(OR=10.317,95％CI为2.086～51.025,P=0.004)是神经损伤恢复的独立预测因素.结论颅神经损伤在隐球菌性脑膜炎中很常见,其发生率与确诊时间延长、颅内压增高及脑脊液有核细胞数降低有关,而受累神经数量和联合治疗是神经恢复的独立预测因素.早期诊断和积极有效抗真菌治疗对防治颅神经损伤至关重要.
목적 료해비AIDS상관은구균성뇌막염환자병발로신경손상적위험인소급예후인소.방법 회고성분석복단대학부속화산의원2000년1월지2010년12월주원치료적은구균성뇌막염145례,총결림상특정、항진균치료화회복정황.채용다인소분석법대상관위험인소화예후인소진행연구.련속변량채용f검험,리산변량채용x2검험혹Fisher학절개솔검험.결과 145례환자중52례출현로신경손상,발생솔위35.9％,기중시신경、동안신경、은신경、외전신경、후신경화면신경수루분별위25、22、12、6、4、3례,분별점소유로신경손상환자적48.1％、42.3％、23.1％、11.5％、7.7％화5.8％.학진시간시발생로신경손상적최강위험인소(OR=1.056,95％ CI위1.002～1.111),진단시간매연장1주,로신경손상발생솔취증가5.6％.로내압고급뇌척액유핵세포수강저야시발생로신경손상적독립예측인소(균P＜0.05).발생로신경손상후유73.3％환자가이완전회복,회복중위시간위3개월(0.5～24.0개월).수루신경수량(OR=0.230,95％CI위0.066～0.800,P=0.021)화량성매소B연합삼서류약물치료(AmB+ 5-FC+삼서류약물)(OR=10.317,95％CI위2.086～51.025,P=0.004)시신경손상회복적독립예측인소.결론 로신경손상재은구균성뇌막염중흔상견,기발생솔여학진시간연장、로내압증고급뇌척액유핵세포수강저유관,이수루신경수량화연합치료시신경회복적독립예측인소.조기진단화적겁유효항진균치료대방치로신경손상지관중요.
Objective To understand the predictors and prognostic significance of cranial nerve impairment in non-acquired immune deficiency syndrome (AIDS) patients with cryptococcal meningitis.Methods A total of 145 non-AIDS patients with cryptococcal meningitis admitted to Huashan Hospital,Fudan University from Jan 2000 to Dec 2010 were reviewed retrospectively.Clinical characteristics,initial antifungal therapies and outcome of these patients were analyzed.Continuous variables were analyzed using t test and categorical variables were compared by x2 test or Fisher's exact test.Multivariate analysis was performed by binary Logistic regressions.Results Out of 145 patients,52 (35.9％) patients had cranial nerve impairment at enrollment.Optic (25/52,48.1％) and oculomotor (22/52,42.3％) nerves were the most commonly involved,followed by auditory (12/52,23.1％),abducens (6/52,11.5％),olfactory (4/52,7.7％) and facial (3/52,5.8％) nerves.The best predictive factor of cranial nerve injury was duration of diagnosis (OR =1.056,95％ CI:1.002-1.111).The risk of cranial injury would increase by 5.6％ with one-week delay of diagnosis.Intracranial hypertension and low cerebrospinal fluid cell count were also the independent predictive factors (both P＜0.05).In the follow-up period,73.3％ patients who had cranial nerve injuries were fully recovered,with a median time of 3 (0.5-24.0) months.The independent predictors of recovery were numbers of nerve involved (OR =0.230,95 ％ CI:0.066-0.800,P=0.021) and amphotericin B (AmB) plus 5-fluorocytosine,triazole antifungal agent therapy (OR=10.317,95％CI:2.086-51.025,P=0.004).Conclusions Cranial nerve impairment occurs in one-third of non-AIDS patients with cryptococcal meningitis.Delay in diagnosis,intracranial hypertension and low cerebrospinal fluid cell count are independent predictive factors.Less cranial nerve involvement and AmB plus triazole therapy predict recovery.