系统性红斑狼疮并发新生隐球菌病7例分析并文献复习

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 mmH2 O），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200×106／L，1例为335×106／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。%Objective To analyze the characteristics of patients with systemic lupus erythematosus( SLE) and crypto-coccus neoformans,in order to improve the clinical diagnosis and treatment level.Methods Retrospective review of the clini-cal features,treatment and outcome of 7 patients with SLE and cryptococcus neoformans, who admittd in Nanjing Jinling Hospi-tal from January 2009 to December 2015.Results The age of the patients ranged from 18 to 49 years(mean 28 years),1 was male and 6 were female.Of the 7 patients, 6 were cryptococcal meningitis, 1 was cryptococcus of lung.None of the 7 patients has HIV.All 7 patients were given methylprednisolone impact treatment before the onset, followed by single steroid or immuno-suppressive therapy.2 patients had contact with pigeons, 1 patient had contact with poultry.4 patients were positive for the an-tigen of serum , and 3 were not tested;5 of the patients got lumbar puncture, 4 of the cerebrospinal fluid culture were positive, all of the ink stain were negative, 4 cases with blood culture were also positive, 3 cases had high intracranial pressure, the highest one was more than 350 mmH2 O, 1 patient had ventricular incision and drainage, 1 had lumbar puncture drainage.5 cases the number of CD4 +T cell was lower than 200 ×106/L,and 1 case was 335 ×106/L.4 patients were cured, 2 patients gave up treatment ( final death) , and 1 patient died.Conclusion The incidence of SLE with cryptococcus neoformans is low, but the mortality is high.It may be related to the use of immunosuppressive agents and glucocorticoids.Early diagnosis and treatment are the key to improve the cure of the disease.