系统性红斑狼疮并发新生隐球菌病7例分析并文献复习
本文选题:红斑狼疮 + 系统性 ; 参考:《疑难病杂志》2016年10期
【摘要】:目的分析系统性红斑狼疮并发新生隐球菌病的临床特点,以提高临床诊疗水平。方法回顾性分析2009年1月—2015年12月南京军区南京总医院肾脏科诊治系统性红斑狼疮并发新生隐球菌病患者7例的临床特点、实验室检查结果、治疗及转归,并复习相关文献。结果 7例患者中男1例,女6例,年龄18~49(28.1±11.2)岁;6例表现为隐球菌性脑膜炎,1例考虑肺部隐球菌病;7例均无人类免疫缺陷病毒感染,起病前均曾给予甲泼尼龙冲击治疗,后续单用激素或激素联合免疫抑制剂治疗;2例有明确的鸽子接触史,1例有家禽接触史;4例接受血隐球菌抗原检测滴度均阳性;5例行脑脊液检查,脑脊液墨汁染色均阴性,4例脑脊液培养阳性,4例血培养阳性,3例颅内压明显增高(最高350 mmH_2O),1例曾行脑室切开引流,1例治疗过程中出现脑积水行腰椎穿刺脑脊液持续引流。5例患者发病时CD4~+数目低于200×10~6/L,1例为335×10~6/L,1例未查。例1单用伊曲康唑,例4单用大扶康,例5予两性霉素B联用大扶康,例6予大扶康联用两性霉素B,均治愈;例2单用两性霉素B,例3予大扶康联用米卡芬净,放弃治疗最终死亡;例7予两性霉素B、氟胞嘧啶片、大扶康治疗后死亡。结论系统性红斑狼疮并发隐球菌性脑膜炎发生率低,但病死率较高,可能和免疫抑制剂和糖皮质激素的应用有关,早期明确诊断和及时治疗是提高此病治愈的关键。
[Abstract]:Objective to analyze the clinical features of systemic lupus erythematosus complicated with Cryptococcus neoformans. Methods from January 2009 to December 2015, 7 patients with systemic lupus erythematosus complicated with Cryptococcus neoformans were retrospectively analyzed. Results among the 7 patients, 1 male and 6 female, aged 180.49 (28.1 卤11.2) years old, showed Cryptococcal meningitis. One case of Cryptococcosis in the lung was not infected by human immunodeficiency virus. All of them were treated with methylprednisolone before onset of the disease. Two cases of pigeon contact were treated with hormone or hormone combined with immunosuppressant alone. One case had a history of contact with poultry. 4 cases had a history of contact with poultry. 5 cases were examined with cerebrospinal fluid (CSF), the titers of blood Cryptococcus antigen were all positive. 4 cases of cerebrospinal fluid culture positive and 3 cases of intracranial pressure significantly increased (up to 350 mm H2O) 1 case with intraventricular incision drainage and 1 case with hydrocephalus and lumbar puncture cerebrospinal fluid in the course of treatment, 4 cases of cerebrospinal fluid culture positive and 4 cases of positive blood culture increased intracranial pressure (up to 350 mm H2O) 1 case had hydrocephalus during the treatment process, 1 case had hydrocephalus. The number of CD4 ~ less than 200 脳 10 ~ 6 / L in 1 case with continuous drainage was 335 脳 10 ~ 6 / L ~ (-1). Case 1 was treated with itraconazole alone, case 4 with Dafukang, case 5 with amphotericin B combined with Dafukang, case 6 with amphotericin B, case 2 with amphotericin B and case 3 with mikafennet. Case 7 died after treatment with amphotericin B, fluorocytosine tablets and Dafukang. Conclusion the incidence of cryptococcal meningitis in systemic lupus erythematosus is low, but the mortality is high, which may be related to the application of immunosuppressant and glucocorticoid. Early diagnosis and timely treatment are the key to improve the cure of the disease.
【作者单位】: 南京军区南京总医院肾脏科/国家肾脏疾病临床医学研究中心/全军肾脏病研究所;
【分类号】:R593.241;R519.4
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