关键词: 结核, 脑膜, 脑膜炎, 隐球菌性, 诊断, 鉴别, 疾病特征, 病例对照研究

Abstract:

Objective To summarize and analyze the clinical features of cryptococcus neoformans meningitis (CNM) and tuberculous meningitis (TBM), and to improve the diagnosis and differential diagnosis of CNM and TBM. Methods From January 2016 to December 2017, 32 CNM patients and 171 TBM patients who admitted to Chengdu Municipal Public Health Clinical Medical Center were included in this study. General information (including age, gender, living area, and whether complicated with low immune function or not), clinical symptoms (including headache, fever, vomiting, respiratory symptoms, convulsions, meningeal irritation, and pathology), cerebrospinal fluid (CSF) laboratory test indicators (including CSF pressure, cell number, lymphocyte proportion, protein level, and glucose content), and CT scan results (normal, cerebral edema, hydrocephalus, brain parenchymal nodular changes, and multiple softening lesions) were compared between CNM and TBM patients.Results The age of patients with TBM was (39.23±12.77) years old, greater than that of CNM patients ((28.71±11.29) years old), and the difference was statistically significant (t=4.35, P=0.000). The occurrence rate of respiratory symptoms, convulsions, change in brain parenchymal nodules, and multiple softening lesions indicated by cranial CT scan in patients with TBM were 94.74% (162/171), 35.09% (60/171), 41.52% (71/171), and 38.01% (65/171), which were significantly higher those in CNM patients (34.38% (11/32), 15.62% (5/32), 6.25% (2/32), and 9.38% (3/32)), and the differences were statistically significant (χ ² values were 73.26, 4.69, 13.07, and 8.68; P values were 0.000, 0.030, 0.000, and 0.003). The rate of low immune function (including complication with HIV infection, urinary glucose disease, organ transplantation, long-term oral glucocorticoids or immunosuppressive agents) and cerebral edema indicted by cranial CT scan in CNM patients were 34.38% (11/32) and 46.88% (15/32), respectively, which were higher than those in TBM patients (18.13% (31/171) and 25.15% (43/171)); the differences were statistically significant (χ ² values were 4.34 and 6.24; P values were 0.037 and 0.013). Regarding the CSF laboratory examination, the number of CSF cells, protein level (median (quartile, Q₁, Q₃)), and glucose content in the TBM patients were 208.00 (178.00, 240.00)×10 ⁶/L, 1058.00 (940.00, 1204.00) mg/L, and (1.77±0.79) mmol/L, respectively, which were significantly higher than those in patients with CNM (64.50 (51.00, 81.00)×10 ⁶/L, 764.00 (608.00, 894.50) mg/L, and (0.25±0.17) mmol/L); the differences were statistically significant (Z=-76.77, P=0.000; Z=-6.83, P=0.000; t=10.82, P=0.000). The CSF pressure of CNM patients was ((273.42±71.58 mm H₂O) (1mm H₂O=0.098 kPa)), which was signi-ficantly higher than that of TBM patients (214.22±88.38 mm H₂O). The difference was statistically significant (t=3.57, P=0.000). Conclusion Compared with TBM patients, CNM patients have higher occurrence rates of complication with low immune function and cerebral edema indicated by cranial CT scan, but lower occurrence rate of respiratory symptoms and convulsions, as well as parenchymal nodule changes and multiple softening lesions indicated by cranial CT scan.

Key words: Tuberculosis, meningeal, Meningitis, cryptococcal, Diagnosis, differential, Disease attri-butes, Case-control studies