目的：分析新型隐球菌脑膜炎和结核性脑膜炎的不同临床特点。方法：对115例结核性脑膜炎和24例新型隐球菌脑膜炎患者的临床资料进行回顾性分析。结果：结核性脑膜炎患者入院时平均体温、脑脊液白细胞数量、脑脊液蛋白浓度、脑脊液葡萄糖浓度均明显高于新型隐球菌脑膜炎组患者(P<0.05)。结论：除氯化物外，新型隐球菌脑膜炎患者脑脊液各项指标均低于结核性脑膜炎。

Objective:To analyze the clinical characters and prognosis of tuberculous meningitis(TBM) and cryptococcus neoformans meningitis(CNM).Method:We retrospectively analyzed the clinical data of 115 patients with tuberculous meningitis and 24 patients with cryptococcus neoformans meningitis.The relevant medical literature was reviewed.Result:Compared with cryptococcus neoformans meningitis,the average body temperature from onset to hospitalized,the quantity of cells and the level of protein and glucose in CSF of tuberculous meningitis were higher(P 0.05).Conclusion:The available indicators in CSF of cryptococcus neoformans meningitis are lower than that of tuberculous meningitis,except the levels of chloride in CSF.

目的比较初发隐球菌性脑膜炎患者治疗前后与健康对照人群外周血CD4+T细胞中Th9和Th17细胞的比值,探讨Th9和Th17细胞在隐球菌性脑膜炎发病机制中的作用。方法选取初发未经治疗隐球菌性脑膜炎患者及健康对照各12例,抽取隐球菌性脑膜炎患者治疗前和治疗后3周及健康对照的外周血,分离外周血单核细胞,应用流式细胞仪检测技术对3组病例外周血CD4+T细胞中Th9和Th17的比值进行比较。结果与健康对照相比,隐球菌性脑膜炎患者治疗前Th17表达下调,差异有统计学意义;在治疗好转患者中,治疗后Th17表达显著上调,与治疗前及健康对照相比差异均有统计学意义。Th9在治疗前与健康对照相比无差异,在治疗后隐球菌性脑膜炎患者中表达上调。结论 Th17免疫途径是隐球菌性脑膜炎患者抵御隐球菌感染的重要免疫机制,隐球菌性脑膜炎发病及治疗拮抗可能与Th17缺乏有关。

Objective To explore the role of Th9 and Th17 cells in the pathogenesis of CM by mesureing the ratio of Th9 and Th17 cells in CD4 + T lymphocyte of patients with cryptococcal meningitis(CM). Methods Twelve CM patients without antifungal treatment and 12 healthy controls were selected. The peripheral blood was collected from patients prior treatment and three weeks af-ter treatment and the healthy controls. The ratio of Th9 and Th17 cells in peripheral blood were analyzed by flow cytometry. Result The ratio of Th17 cells in patients with CM before treatment was less than those of healthy people,and patients who received treat-ment showed the increased level of Th17 cells which was higher than those in patients before treatment and the healthy controls. The ratioof Th9 also increased in the patients who received treatment while there was no significant different between the patients before treatment and the healthy controls. Conclusion Th17 immune pathway is an important immune mechanism

目的分析新型隐球菌脑膜炎的易感因素、临床特点、治疗及转归。方法回顾性分析2000年12月至2011年10月确诊的46例新型隐球菌脑膜炎。总结其临床表现、实验室检查、治疗及转归情况。结果46例患者均经脑脊液墨汁染色阳性确诊。22例（47．83％）合并有其他免疫系统疾病。治愈9例、好转18例、6例死亡、13例自动出院。结论患有免疫系统疾病是新型隐球菌脑膜炎的易感因素之一，在患有免疫系统疾病患者中出现发热、头痛等脑膜刺激征阳性，应及时行腰穿，反复行脑脊液墨汁涂片找隐球菌，及时明确诊断，联合鞘内注射两性霉素B能缩短脑脊液隐球菌转阴时间，以提高隐球菌脑膜炎临床疗效。

Objective To analyze the susceptible factors,clinical characteristics,treatments and prognosis of cryptococcal neoformans meningitis. Methods Forty-six patients with cryptococcal neoformans meningitis admitted to the first hospital affiliated to Soochow university from 2000 to 2011 were retrospectively analyzed.Clinical manifestations,data of laboratory examination,treatments and outcome were analyzed. Results All forty-six patients were diagnosed by cerebrospinal fluid ink staining positive.Twenty-two patients had immune system diseases,accounting for 47.83%.The outcome of 46 cases showed that 9 patients were cured,18 improved,6 patients died and 13 gave up any further treatment. Conclusion Suffering from the immune system disease is one of the susceptible factor of cryptococcus neoformans meningitis.People with immune system diseases have symptoms such as headache,fever or meningeal stimulation,should be timely treated with lumbar puncture and the cerebrospinal fluid must b

肺隐球菌病是由新型隐球菌感染引起的肺深部真菌病。若肺隐球菌病得不到及时诊断治疗,可致全身感染,严重者可引起隐球菌脑膜炎。其好发于艾滋病患者,然而在免疫力正常的个体中报道也逐渐增多。本文回顾性分析1例原发性肺隐球菌病患者的诊断和治疗过程,总结治疗经验,并结合相关文献复习肺隐球菌病的临床表现、诊断与治疗要点,以提高临床医师对肺隐球菌病的认识。

Pulmonarycryptococcosis,causedbycryptococcusneoformansinfectiondeepinlungs,cancausesystemic infection or even cryptococcal meningitis if not diagnosed or treated timely. It often appears in AIDS patients,but increasingly in individuals with normal immunity. This paper analyzes retrospectively the diagnosis and treatment process of pulmonary cryptococ-cosis,summarizes the experience of treatment and reviews the literatures on its clinical manifestations,the key points for its diag-nosis and treatment,to improve clinicians′awareness about pulmonary cryptococcosis.

目的 探讨近两个10年中枢神经系统感染患者的病因构成、发病年龄、误诊率、住院时间和预后的变化.方法 回顾对比分析1993年1月至2002年12月(A组,共346例)与2003年1月至2012年12月(B组,共412例)皖南医学院附属弋矶山医院收治的中枢神经系统感染者中,化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎的构成比;根据患者的年龄、性别、基础疾病、入院前免疫抑制剂的应用等,分析其变迁的原因.并比较两组组中和组间各病因的入院前误诊率、住院时间和预后.计量资料行方差分析或t检验,计数资料行x2检验.结果 两组化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎的构成比分别为24.3％比20.1％、29.5％比35.7％、6.6％比11.4％、39.6％比32.8％(x2=10.61,均P＜0.05).与A组相比,B组患者年龄较大[(38.8±8.9)岁比(43.8±11.4)岁,t=6.73,P＜0.05];基础疾病较多[(1.21±0.34)个比(1.72±0.41)个,t=18.41,P＜0.05];免疫抑制剂应用时间较长[(7.76±3.58)d比(12.43±5.96)d,t=12.77,P＜0.05].两组性别比较,差异无统计学意义(x2=0.97,P＞0.05).A组化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎入院前误诊率分别为9.5％、42.2％、69.6％和12.4％;平均住院时间分别为(11.02±5.13)、(19.18±8.34)、(21.12±9.26)和(8.24±3.17)d;好转率分别为88.1％、60.8％、34.8％和80.3％.B组化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎入院前误诊率分别为8.4％、29.3％、42.6％和11.1％;平均住院时间分别为(10.13±4.25)、(17.26±5.82)、(23.05±7.97)和(7.05±2.94)d;好转率分别为90.4％、72.8％、61.7％和84.4％.两组间结核性脑膜炎、隐球菌性脑膜炎入院前误诊率和好转率比较,差异均有统计学意义(均P＜0.05).结论 随着机体基础疾病的增多和免疫抑制剂广泛应用,中枢神经系统感染病种存在变迁,其中结核性脑膜炎和隐球菌性脑膜炎有增多趋势,且易被误诊、预后较差.

Objective To explore the changes of etiological factors,age of onset,misdiagnosis rates,length of stay and prognosis in central nervous system (CNS) infections between the near 2 decades.Methods A retrospective analysis was conducted between hospitalized patients with CNS infections in affiliated Yijishan Hospital of Wannan Medical College from January 1993 to December 2002 (group A,n =346) and from January 2003 to December 2012 (group B,n =412).The proportions of bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections between the 2 groups were comparable.Age,gender,underlying diseases and prehospitalization applications of immunosuppressant in two groups were analyzed.The data of prehospitalization misdiagnosis rates,length of stay and prognosis of the two groups were also compared.Measurement data were analyzed by variance analysis or t test,and enumeration data were analyzed by x2 test.Results The proportions of bacterial infections,My