【作者】 卢洪洲； 周颖杰； 尹有宽； 潘孝彰； 翁心华；

【Author】 Yingjie Zhou, Hongzhou Lu, Youkuan Yin, Xiaozhang Pan, and Xinhua Weng (Department of Infectious Diseases, Fudan University Huashan Hospital, Shanghai 200040, People’s Republic of China)

【机构】 复旦大学附属华山医院传染病科；

【摘要】 目的了解隐球菌抗原乳胶检测系统对新型隐球菌性脑膜炎诊断及治疗的意义。方法:对4 年来在华山医院住院的107例确诊为隐脑的患者中的29例有治疗前后乳胶凝集试验滴度变化资料的隐脑病例作回顾性分析。采用美国Immuno-Mycologics有限公司生产的隐球菌抗原乳胶检测系统进行定量和半定量检测。结果29例HIV-1抗体阴性的隐脑患者中,有明确鸽粪接触史者5例(17．2％)。有其他基础疾病者13例(44．8％)。病人从发病到确诊并开始治疗的时间为10到260天(49．1±54．0天)。治疗前乳胶凝集试验均为阳性。治疗前后,隐球菌荚膜抗原乳胶凝集试验滴度的明显下降,与脑脊液(CSF) 白细胞计数、糖、氯化物、涂片墨汁染色、以及真菌培养明显改善的变化一致,且这些变化都有统计学意义。总蛋白水平在治疗后也显著下降,但是没有统计学意义。经过治疗,真菌涂片及培养转阴后,乳胶凝集试验仍可为阳性。结论研究表明,隐球菌抗原乳胶凝集试验用于诊断隐脑特异性高,但对治疗的指导意义有限。治疗方案及疗程应依据患者的症状、体征及CSF病原学的检查,当CSF生化(主要考虑糖、氯化物)、常规(白细胞为主)正常后,停止静脉给药,采取氟康唑合并5-FC口服进行序贯治疗。2月后复查CSF常规、生化仍正常者可停药。更多还原

【Abstract】 Objective: To investigate the significance of the latex agglutination test for cryptococcal capsular antigen in the diagnosis and treatment of cryptococcal meningitis. Methods: A retrospective analysis was conducted in 107 cases of cryptococcal meningitis in Huashan Hospital over the past 4 years, and from these 107 cases, 29 cases were selected in which there was documentation of the titration changes in the latex agglutination test before and after therapy. The Latex-Crypto Antigen Detection System (Immuno Mycologies, Inc., Norman, OK) was used for the qualitative and semi-quantitative detection. Results: Among the 29 cases, five (17.2%) had a recent exposure history to pigeons droppings and 13 (44.8%) had underlying diseases. Patients were diagnosed and started therapy 10 to 260 (49.1 ±54.0) days after the onset of disease. The cryptococcal antigen latex agglutination test was positive pre-therapy with the titers ranging from 1:80 to 1:5210. There was a remarkable decrease in cryptococcal antigen titers pre- and post-therapy which was significantly related to the CSF leukocyte count, glucose, chloride, fungal smear and fungal culture. The total protein level in CSF was decreased post-therapy, but the difference was not statistically significant. The cryptococcal antigens can remain detectable even months following successful therapy. Conclusion: The cryptococcal antigen latex agglutination test is highly specific in the diagnosis of cryptococcal meningitis; however the significance of monitoring therapy is limited. The therapy protocols should be based on the symptoms, the physical signs, and examination for the organism from CSF. Intravenous antifungal therapy should be discontinued and oral fluconazole and 5-FC, as a sequential therapy, should be initiated when the CSF glucose, chloride levels and leucocyte count become normal. Sequential therapy was eventually stopped if the above CSF parameters remained normal for two months.更多还原