结核性脑膜炎患者预后的相关因素分析

目的研究影响结核性脑膜炎（TBM）患者预后的相关因素。方法回顾性分析广元市第三人民医院2006年1月～2012年12月收治的156例TBM患者的临床资料,采用改良Barthel指数（BI）评定患者出院恢复情况并分组,BI≥12分为恢复良好,〈12分或死亡为恢复不良;研究影响患者恢复不良的相关因素,采用Logistic回归分析影响患者预后的独立危险因素。结果①本组156例TBM患者,治疗后出院148例（94.87%）,其中BI≥12分者102例（65.38%,恢复良好组）,BI〈12分者46例（29.49%,恢复不良组）;治疗无效死亡8例（5.13%）,其中呼吸衰竭死亡4例（2.56%）,脑疝死亡2例（1.28%）,多器官功能衰竭死亡1例（0.64%）,上消化道出血导致低血容量性休克1例（0.64%）。②恢复不良组患者肢体瘫痪、脑积水和脑脊液（CSF）蛋白含量高于恢复良好组,恢复不良组格拉斯哥昏迷评分（GCS）和CSF氯化物含量低于恢复良好组,差异均有统计学意义（P〈0.01或P〈0.05）。③多因素分析结果显示,脑积水、GCS评分和CSF蛋白含量是TBM患者恢复不良的独立危险因素（P〈0.05）。结论肢体瘫痪、脑积水、GCS评分、CSF氯化物含量和CSF蛋白含量与TBM患者恢复不良密切相关,其中GCS评分、CSF蛋白含量及脑积水是影响TBM患者预后的独立危险因素。

Relative factors analysis on prognosis of patients with tubercular meningitis

Objective To study the relative factors on prognosis of patients with tubercular meningitis（TBM）.Methods The clinical data of 156 TBM patients treated in the Third People′s Hospital of Guangyuan City from January 2006 to December 2012 were analyzed retrospectively.The recovery of patients after discharge was evaluated and divided into groups by using the improved Barthel index（BI）.Patients with the BI ≥12 scores were defined as good recovery,and the patients with BI 12 scores were defined as bad recovery.The related factors of influencing bad recovery were studied.And the independent risk factors influencing prognosis of patients were analyzed retrospectively by Logistic regression analysis.Results ①For 156 patients with TBM,there were 148 cases discharging after treatment（94.87%）,in which there were 102 cases with BI ≥12 scores（65.38%,good recovery group）,there were 46 cases with BI 12 scores（29.49%,bad recovery group）.There were 8 cases dead because of ineffective treatment（5.13%）,4 cases dead with respiratory failure（2.56%）,2 cases dead with cerebral hernia（1.28%）,1 case dead with multiple organ failure（0.64%）,and 1 case dead with hypovolemic shock because of upper gastrointestinal hemorrhage（0.64%）.② Acroparalysis,hydrocephalus,cerebrospinal fluid（CSF） protein content in bad recovery group were higher than those in good re covery group,Glasgow coma score（GCS） score and CSF chloride content in bad recovery group were lower than those in good recovery group,the differences were statistically significant（P 0.05）.③Hydrocephalus,GCS score and CSF protein content were the independent risk factors for the bad recovery of patients with TBM（P 0.05） according to the multi-factor analysis.Conclusion Acroparalysis,hydrocephalus,CSF score,CSF chloride content and CSF protein content have close relationship with the bad recovery of patients with TBM,in which CSF score,CSF protein content and hydrocephalus are independent risk factors influencing prognosis of patients with tubercular meningitis.