中枢神经系统真菌感染的诊断与治疗

分析中枢神经系统真菌感染患者的临床特征、预后及其影响因素。收集我院2001年1月至2009年12月收治的42例中枢神经系统真菌感染患者的临床资料,对患者的诊断与误诊、实验室和病原学检查、治疗与预后等进行回顾性统计分析。42例患者中合并其他疾病者29例,占69.0%;首诊误诊32例,占76.2%。两性霉素B(AmpB)治疗者25例,其中6例在疾病早期联合5-氟胞嘧啶治疗,15例单用氟康唑治疗。治愈20例,占47.6%;好转11例,占26.2%;死亡11例,占26.2%。中枢神经系统真菌感染误诊率高,各种原因所致的免疫缺陷是引发中枢神经系统真菌感染的主要危险因素,尽早明确诊断,联合AmpB与5-FC抗真菌治疗、积极控制颅内压是降低病死率及改善预后的关键。

Diagnosis and Treatment of Fungal Infection in Central Nervous System

In order to investigate the clinical features,prognosis and effective factors of patients with fungal infection in central nervous system（FICNS）,a totally 42 patients with（FICNS）who were hospitalized in the First affiliated Hospital of Harbin Medical University from January 2001 to December 2009 were statistically analyzed in reviewing their clinical data including diagnosis and misdiagnosis,laboratory and aetiological tests,treatment and prognosis.The results showed that among the 42 patients 29 patients（69.0%）had complication.The misdiagnosis at first diagnosis was 32 cases accounting for 76.2%.Treatments with Amphotericin B（AmpB）25cases,among them 6 cases were treated with a combination of 5-flucytosine（5-FC）,15 cases treated with fluconazole.20 cases（47.6%）cured,11 cases（26.2%）improved,and 11 cases（26.2%）died.Therefore,high misdiagnosis rate was common in FICNS,there were various reasons that caused immunodeficiency was the main dangerous factors that induced FICNS;Early tangible diagnosis against time and treatment with combination of AmpB with 5-FC antifungal therapy and actively control intracranial pressure were the keys to lower the death rate and to improve prognosis.