结核性脑膜炎患者预后情况调查及其相关影响因素分析

刘子林 肖绍武 叶琳 况卫丰 张丽婷 周丽 张齐龙

【摘要】 目的：探讨结核性脑膜炎（tuberculous meningitis，TBM）患者预后情况及其相关影响因素。方法：回顾性分析2019年1月-2021年7月就诊于本院的60例TBM患者的临床资料，分析TBM患者预后情况及其相关影响因素。结果：60例TBM患者中，預后良好39例（65.00%），预后不良21例（35.00%）。单因素分析显示，脑积水、意识障碍、脑脊液蛋白含量、脑脊液氯化物含量与TBM患者预后有关，差异均有统计学意义（P<0.05）。年龄、治疗前病程、性别、肢体瘫痪、癫痫发作、疾病分期、激素治疗、合并颅外结核、脑压、脑脊液葡萄糖含量和白细胞计数与TBM患者预后无关，差异均无统计学意义（P>0.05）。多因素分析显示，脑积水、意识障碍、脑脊液蛋白含量≥4 000 g/L、脑脊液氯化物含量<115 mmol/L是影响TBM患者预后的危险因素（P<0.05）。结论：TBM患者预后较差，其受脑积水、意识障碍、脑脊液蛋白含量、脑脊液氯化物含量影响。

【关键词】 结核性脑膜炎 脑积水 预后 意识障碍

Investigation of Prognosis of Tuberculous Meningitis Patients and Analysis of Related Influencing Factors/LIU Zilin， XIAO Shaowu， YE Lin， KUANG Weifeng， ZHANG Liting， ZHOU Li， ZHANG Qilong. //Medical Innovation of China， 2021， 18（35）： 0-072

[Abstract] Objective： To investigate the prognosis and related factors of tuberculous meningitis （TBM）. Method： The clinical data of 60 TBM patients admitted to our hospital from January 2019 to July 2021 were retrospectively analyzed， and the prognosis and related factors of TBM patients were analyzed. Result： Among the 60 patients with TBM， 39 cases （65.00%） had good prognosis and 21 cases （35.00%） had poor prognosis. Univariate analysis showed that hydrocephalus， disturbance of consciousness， CSF protein content and CSF chloride content were correlated with prognosis of TBM patients， the differences were statistically significant （P<0.05）. Age， course of disease before treatment， gender， paralysis of limbs， seizures， disease stage， hormone therapy， extracranial tuberculosis， brain pressure， CSF glucose content and white blood cell count had no significant differences in prognosis of TBM patients （P>0.05）. Multivariate analysis showed that hydrocephalus， disturbance of consciousness， cerebrospinal fluid protein content ≥4 000 g/L， cerebrospinal fluid chloride content <115 mmol/L were high risk factors for prognosis of TBM patients （P<0.05）. Conclusion： TBM patients have a poor prognosis， which is affected by hydrocephalus， disturbance of consciousness， CSF protein content and CSF chloride content.

[Key words] Tuberculous meningitis Hydrocephalus Prognosis Disturbance of consciousness

First-author’s address： Chest Hospital of Jiangxi Province， Nanchang 330006， China

doi：10.3969/j.issn.1674-4985.2021.35.017

结核性脑膜炎（tuberculous meningitis，TBM）属于重症中枢神经系统感染性疾病，是由结核杆菌所致的脊膜、脑膜的非化脓性炎症性疾病，发生率约占神经系统结核的70%[1-2]。TBM发病隐匿，早期无典型性临床表现，待确诊时患者病情较为严重，错过治疗最佳时机，治疗难度较大，且效果较差，病死率较高，而存活的TBM易遗留肢体残疾、意识障碍、癫痫等多种严重后遗症[3-4]。若能了解影响TBM的相关危险因素，早期实施相应的防治措施干预，对于改善患者预后具有积极意义。基于此，本研究统计、分析就诊本院的60例TBM患者的临床资料，探讨TBM患者预后情况及其相关影响因素，现报道如下。……