【摘要】 目的 比较新型隐球菌性脑膜炎(CNM)与结核性脑膜炎(TBM)临床表现、脑脊液(CSF)及影像学改变的差异，探讨2种不同病原体引起的脑膜炎的临床鉴别要点。 方法 对25例CNM和67例TBM患者的临床表现、CSF及影像学资料做回顾性分析。 结果 CNM多呈亚急性或慢性起病，中、低度发热，神经损害的表现出现较晚，视乳头水肿及脑疝多见;TBM多呈急性或亚急性起病，高热多见，神经损害的表现出现较早，腱反射减弱。TBM CSF白细胞计数及蛋白质较CNM高，氯化物较CNM低，葡萄糖较CNM高，CNM颅内压多明显升高，细胞分类两者差异无显著性。影像学改变也有不同的特点，TBM脑膜改变较CNM明显，脑积水多见且较重;CNM患者MRI可见血管周围腔隙扩大。 结论 CNM和TBM临床表现、CSF及影像学改变有一定的差异，这些特点是CNM和TBM鉴别诊断的有用信息。
【关键词】 脑膜炎 隐球菌性 脑膜炎 结核性 临床表现 脑脊液检查 影像诊断
Clinical comparative analysis for patients with cryptococcal neoformans meningitis and tuberculous meningitis YANG Hong，SHE Junhong.Department of Neurology，The Fourth Affiliated Hospital of GuangXi Medical Universi-ty，Guangxi，Liuzhou 545005，China
【Abstract】 Objective To compare the clinical manifestations，cerebrospinal fluid(CSF)，and neuroimaging changes between cryptococcal neoformans meningitis(CNM)and tuberculous meningitis(TBM)in order to investigate the clinical differential points of meningitis caused by the two different pathogens.Methods The clinical manifesta-tions，CSF，neuroimaging changes in25patients with CNM and67patients with TBM were analyzed retrospectively.Results The following items were considered significant:in CNM，the onsetwas subacute or chronic.The patients with CNM usually presented with middle and mild fever，higher intracranial hypertension accompanying papilledema，and lower glucose content of CSF.In TBM:The onset was usually acute or subacute.CSF pleocytosis and absent tendon re-flexes were the more common manifestations.Each meningitis had its own abnormal neuroimaging changes.Conclusion There are some differences in clinical symptoms and signs，CFS and nueroimaging changes between CNM and TBM，which is important in diagnosing and differentiating CNM and TBM.
【key words】 Meningitis，cryptococcal;Meningitis，tuberculous;Clinical manifestation;CFS examination;Diag-nostic imaging
新型隐球菌性脑膜炎(cryptococcal neoformans meningitis，CNM)和结核性脑膜炎(tuberculous menin-gitis，TBM)是临床常见的2种脑
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