免疫球蛋白辅助治疗隐球菌性脑膜炎的临床疗效观察

摘要

目的 观察免疫球蛋白辅助治疗隐球菌性脑膜炎的临床疗效.方法 选取广西壮族自治区桂东人民医院2014年6月-2015年11月收治的隐球菌性脑膜炎患者58例,采用随机数字表法分为对照组和观察组,每组29例.对照组患者采用两性霉素B脂质体联合氟康唑、5-氟胞嘧啶治疗,观察组患者在对照组基础上给予免疫球蛋白辅助治疗.比较两组患者临床疗效和起效时间,治疗前后颅内压、脑脊液生化指标、CD+4 T淋巴细胞计数和CD+8 T淋巴细胞计数,并观察两组患者治疗期间不良反应发生情况.结果 两组患者临床疗效比较,差异无统计学意义(P>0.05);观察组患者起效时间快于对照组(P0.05);治疗后观察组患者颅内压和脑脊液白细胞计数低于对照组,脑脊液蛋白、氯化物及葡萄糖含量高于对照组(P0.05);治疗后观察组患者CD+4 T淋巴细胞计数和CD+8 T淋巴细胞计数高于对照组(P0.05).结论 免疫球蛋白辅助治疗隐球菌性脑膜炎能加快药物起效时间,提高患者免疫功能,降低患者颅内压并控制隐球菌感染.%Objective To observe the clinical effect of immunoglobulin in the adjunctive therapy for cryptococcal meningitis.Methods A total of 58 patients with cryptococcal meningitis were selected in the People′s Hospital of Guidong from June 2014 to November 2015,and they were divided into control group and observation group according to random number table,each of 29 cases.Patients of control group received amphotericin B liposome,fluconazole and 5-fluorocytosine,while patients of observation group received extra immunoglobulin as adjunctive therapy.Clinical effect,time to onset,intracranial pressure,cerebrospinal fluid biochemical indicators,CD+4 cell counts and CD+8 cell counts were compared between the two groups,and incidence of adverse reactions during the treatment was observed.Results No statistically significant differences of clinical effect was found between the two groups(P>0.05),while time to onset of observation group was statistically significantly faster than that of control group(P0.05);after treatment,intracranial pressure and cerebrospinal fluid WBC of observation group were statistically significantly lower than those of control group,cerebrospinal fluid contents of protein,chloride and glucose of observation group were statistically significantly higher than those of control group after treatment(P0.05),while CD+4 cell counts and CD+8 cell counts of observation group were statistically significantly higher than those of control group after treatment(P0.05).Conclusion Immunoglobulin can effectively quicken the time to onset in the adjunctive therapy for cryptococcal meningitis,improve the immunological function and reduce the intracranial pressure,is helpful to control the cryptococcal infection.