摘要： 目的 总结新型隐球菌性脑膜炎和（或）脑炎临床特点，为早期诊断和有效治疗提供经验。方法与结果 回顾分析102 例新型隐球菌性脑膜炎和（或）脑炎患者临床特点，主要表现为缓慢进展的颅内高压症状、脑膜刺激征和脑神经损害症状，累及脑实质者可出现癫发作、偏瘫、精神障碍、共济失调等。新型隐球菌性脑膜炎和（或）脑炎误诊率较高，尤其易误诊为结核性脑膜炎，对疑似患者，反复多次脑脊液细菌涂片、乳胶凝集试验和影像学检查相结合，可提高诊断准确性。两性霉素B 与氟胞嘧啶诱导治疗后联合氟康唑维持治疗是目前临床常用治疗方案，可取得较好疗效，外科手术（如侧脑室-腹腔分流术）是治疗合并脑积水的新型隐球菌性脑膜炎和（或）脑炎的有效方法。结论 新型隐球菌性脑膜炎和（或）脑炎临床表现缺乏特异性，极易误诊，对于疑似患者，应反复多次行脑脊液细菌涂片，结合乳胶凝集试验和影像学检查尽早明确诊断。对于诊断明确的患者应采用联合、长期抗真菌治疗方案，必要时积极采取外科手术治疗，改善患者预后。

关键词: 隐球菌, 新型, 脑膜炎, 脑炎, 抗真菌药

Abstract: Objective  To summarize the clinical manifestations and diagnostic and therapeutic strategies of 102 cases with cryptococcal meningitis and/or cryptococcal meningoencephalitis, and to improve the diagnosis and treatment of cryptococcal meningitis.  Methods  The clinical manifestations, diagnostic and therapeutic strategies and outcomes of 102 cases with cryptococcal meningitis and/or cryptococcal meningoencephalitis were analyzed retrospectively.  Results  The incidence of cryptococcal meningitis and/or cryptococcal meningoencephalitis raised in recent years. The signs of high intracranial pressure, meningeal irritation and cranial nerves impairment are the main clinical manifestations of cryptococcal meningitis, while seizures, hemiplegia, mental disorders and ataxia can occur when the brain parenchyma is involved. Cryptococcal meningitis and/or cryptococcal meningoencephalitis is easy to be misdiagnosed, especially misdiagnosed as tuberculous meningitis. Repeated cerebrospinal fluid (CSF) smear and latex agglutination test can ensure the diagnostic accuracy. Amphotericin B, flucytosine and fluconazole combined therapy is the most widely used therapeutic strategy at present, which has been proved to be effective; surgery operations (such as ventriculo-peritoneal shunt) are effective in the treatment of cryptococcal meningitis complicating hydrocephalus.  Conclusions  The diagnosis of cryptococcal meningitis and/or cryptococcal meningoencephalitis is difficult for its lack of specific clinical manifestations. Suspected patients should receive repeated CSF smear, latex agglutination test as well as imageological examination to make an accurate diagnosis. Combined, long-term antifungal therapy should be used immediately in confirmed cases, and surgery operations can be used in necessity to improve outcomes.

Key words: Cryptococcus neoformans, Meningitis, Encephalitis, Antifungal agents