本文選題：紅斑狼瘡 + 系統(tǒng)性�。� 參考：《疑難病雜志》2016年10期

【摘要】：目的分析系統(tǒng)性紅斑狼瘡并發(fā)新生隱球菌病的臨床特點,以提高臨床診療水平。方法回顧性分析2009年1月—2015年12月南京軍區(qū)南京總醫(yī)院腎臟科診治系統(tǒng)性紅斑狼瘡并發(fā)新生隱球菌病患者7例的臨床特點、實驗室檢查結果、治療及轉歸,并復習相關文獻。結果 7例患者中男1例,女6例,年齡18~49(28.1±11.2)歲;6例表現(xiàn)為隱球菌性腦膜炎,1例考慮肺部隱球菌病;7例均無人類免疫缺陷病毒感染,起病前均曾給予甲潑尼龍沖擊治療,后續(xù)單用激素或激素聯(lián)合免疫抑制劑治療;2例有明確的鴿子接觸史,1例有家禽接觸史;4例接受血隱球菌抗原檢測滴度均陽性;5例行腦脊液檢查,腦脊液墨汁染色均陰性,4例腦脊液培養(yǎng)陽性,4例血培養(yǎng)陽性,3例顱內壓明顯增高(最高350 mmH_2O),1例曾行腦室切開引流,1例治療過程中出現(xiàn)腦積水行腰椎穿刺腦脊液持續(xù)引流。5例患者發(fā)病時CD4~+數(shù)目低于200×10~6/L,1例為335×10~6/L,1例未查。例1單用伊曲康唑,例4單用大扶康,例5予兩性霉素B聯(lián)用大扶康,例6予大扶康聯(lián)用兩性霉素B,均治愈;例2單用兩性霉素B,例3予大扶康聯(lián)用米卡芬凈,放棄治療最終死亡;例7予兩性霉素B、氟胞嘧啶片、大扶康治療后死亡。結論系統(tǒng)性紅斑狼瘡并發(fā)隱球菌性腦膜炎發(fā)生率低,但病死率較高,可能和免疫抑制劑和糖皮質激素的應用有關,早期明確診斷和及時治療是提高此病治愈的關鍵。
[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 鹵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.
【作者單位】： 南京軍區(qū)南京總醫(yī)院腎臟科/國家腎臟疾病臨床醫(yī)學研究中心/全軍腎臟病研究所;
【分類號】：R593.241;R519.4

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相關期刊論文 前10條

1 高二志;楊茜;李U，

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