| Objective:The aim of this study was to explore the clinical characteristics of Cryptococcal meningitis(CM)and the application value of serum uric acid in the development and prognosis assessment of CM.Methods:Collected the Clinical,blood,cerebrospinal fluid(CSF)and iconography informa-tion of 53 CM patients who were treated in the First Affiliated Hospital of Nanchang University from January 2009 to December 2016.In the same period,52 healthy patients were treated as control group.1.To summarize the clinical characteristics of CM patients by analyzing the age,sex,presence or absence of basic disease,clinical manifestations,blood routine and electrolytes.2.33 patients who had adhered to antifungal therapy in our hospital from 53 patients were divided into cured group,improved group and ineffective group according to the criteria of Cryptococcal meningitis.Retrospective analysis was showed by medical records of 33 patients,including age,gender,presence or absence of basic disease,the first laboratory indicators(CSF routine,CSF biochemistry,serum uric acid),serum uric acid level after three weeks treatment.Results:1.53 cases of CM patients,the 30(56.6%)were female,23(43.4%)were female,the pathogenesis of 40(75.5%)were acute,11(20.8%)were subacute,2(6.7%)were chronic,the average duration was 21.08±17.00 days,the shortest one was 7days,the longest one was three months.49 cases(92.5%)had headache,38 cases(71.7%)had fever,30 cases(56.6%)had nausea and vomiting,,2 cases(3.8%)had vertigo,8cases(15.1%)had vestibular cochlear nerve injury,11 cases(20.8%)had optic nerve injury,3 cases(5.7%)had abducens nerve injury,5 cases(9.4%)had seizure performance,3 cases(5.7%)had mental symptoms,11 cases(20.8%)had disturbanceof consciousness,3 cases(5.7%)had ventilatory dysfunction.40 cases(75.5%)showed meningeal irritation signs positive.26 cases(49.1%)had underlying disease.As many as 14 cases(26.4%)were initially misdiagnosed.2.Assistant examination:There were 12 cases(22.6%)with WBC> 10 ×109/L,neutrophils>70% had 38 cases(71.7%);33 cases(62.3%)were observed with hypoxemia(Na+<135mmol/L),17 cases(32.1%)were found with hypokalemia(K+<3.5mmol/L).SUA was 161.13 ±64.85umol/L in the case group and290.19±70.51umol/L in the control group.43 cases(81.1%)were observed whose CSF glucose was less than 2.5mmol/L,in of which 1.5-2.5mmol/L had 13 cases(24.5%),less than 1.5mmol had 30 cases(56.6%).There were 48 patients with increased CSF protein.There were 48cases(90.6%)those CSF ink staining positive,only ink staining of 40 cases was positive for the first time,4 cases were positive in the second time,2 cases were positive in the third time,2 case was positive in forth time.There were 2 cases that Cryptococcus neoformans were cultivated in CSF.3 patients were diagnosed by the positive latex agglutination test.3.Imaging examination:53 patients were conducted to accomplish cranial MRI,of which 14 cases showed acute cerebral infarction,5 cases had the sign of the ventricular system expanding,one case had the sign of the venous sinus thrombosis,33 cases had no obvious abnormalities.22 cases of 53 cases patients could present enhancement scan images,found that there were 5 cases with varying degrees of meningeal enhancement.4.In the second part,the logistic regression analysis shows that SUA after treatment in cured group and improved group was significantly less than 0.05,respectively 0.025,0.017,when the reference category was ineffective one.So SUA after treatment in the cured and impeoved group were significant difference compared to the ineffective group.When the reference category was cured one,found only CSF glucose in the improved group was significantly less than 0.05(P=0.038).So CSF glucose was significant differences between the improved group and the cured group.Conclusion:1.Cryptococcus is a conditional pathogenic fungi,so immune dysfunction is susceptible to this fungus.But we should be alerted particularly that there waspossible for normal immune function with CM.2.SUA after treatment is the protective factor of the cured group and improved group.3.Campared to the improved group,the first value of CSF glucose is higher,the cure rate would be higher. |
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