Cryptococcal meningitis in adult patients with primary nephrotic syndrome .
Cryptococcal meningitis in adult patients with primary nephrotic syndrome
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复制标题
原发性肾病综合征成年患者的隐球菌性脑膜炎。
DOI：
10.5414/cn109384
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发表时间：
2018
影响因子：
1.1
通讯作者：
Jin Lv
中科院分区：
文献类型：
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作者：
B. Su;Qiankun Zhang;Jin Lv
背景
隐球菌性脑膜炎(CM)在原发性肾病综合征(PNS)患者中是一种罕见的疾病。在这里，我们描述了11名PNS和CM患者的临床特征、可能的危险因素和转归。
材料和方法
对温州医科大学第一附属医院2005-04-2015-04收治的11例PNS合并CM患者的病历资料进行系统回顾。随机抽取同期无感染的PNS住院患者30例为对照组。
结果
平均发病年龄64.6岁(47.8岁~72.2岁)，男女之比为5：6。PNS病程平均14.0个月(1个月~25月)，前一年泼尼松累计用量3.8g±1.98g，平均白蛋白25.8g±110.1g/L，平均血肌酐116.4±64.3g/L，死亡3例，有后遗症存活1例，无后遗症存活7例。不良结局与低血清白蛋白水平(p=0.004)和前一年较高的累积泼尼松剂量(p=0.025)有关。与无感染的PNS患者相比，有CM的患者年龄更大(P<；0.001)，通常血清肌酐水平更高(P<；0.001)。
结论
高龄和高血肌酐水平是PNS患者发生CM的重要危险因素。
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BACKGROUND
Cryptococcal meningitis (CM) is a rare condition in patients with primary nephrotic syndrome (PNS). Here, we describe the clinical characteristics, possible risk factors, and outcomes of eleven patients with PNS and CM.
MATERIALS AND METHODS
A systematic review of medical records from 11 patients with PNS and CM admitted to the First Affiliated Hospital of Wenzhou Medical University from April 2005 to April 2015 was performed. A total of 30 cases were randomly selected as controls from PNS inpatients without infection during the same period.
RESULTS
The mean age at presentation was 64.6 years (range: 47.8 - 72.2 years), and the female-to-male ratio was 5 : 6. The mean duration of PNS was 14.0 months (range: 1 - 25 months); the cumulative prednisone dose over the preceding year was 3.8 ± 1.98 g; the mean albumin level was 25.8 ± 10.1 g/L; the mean serum creatinine level was 116.4 ± 64.3 µmol/L. Three patients died, 1 patient survived with sequelae, and 7 patients survived without sequelae. Unfavorable outcomes were associated with low serum albumin levels (p = 0.004) and higher cumulative prednisone dose over the preceding year (p = 0.025). Compared with PNS patients without infections, those with CM were older (p < 0.001) and usually had higher serum creatinine levels (p < 0.001).
CONCLUSION
Old age and high serum creatinine levels are important risk factors for the development of CM in patients with PNS.
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