结核性脑膜炎预后相关因素分析

目的 探讨结核性脑膜炎患者脑脊液和核磁共振检查与结核性脑膜炎预后的关系.方法 收集2008年9月～2011年8月期间在兰州大学第二医院神经内科、神经外科、急诊科住院的46例结核性脑膜炎患者的临床资料,研究脑脊液参数及核磁共振改变与结核性脑膜预后的关系.结果 脑脊液参数中压力、白细胞数改变、葡萄糖降低、蛋白质改变及核磁共振改变与结核性脑膜炎预后有显著关系.结论 影响结核性脑膜炎预后的因素多种多样,脑脊液参数中白细胞数、葡萄糖含量、蛋白质及核磁共振改变特别是脑积水和脑梗塞与结核性脑膜炎预后密切相关.     

结核性脑膜炎的诊治分析

目的探讨结核性脑膜炎的诊治及其预后。方法对住院诊断结核性脑膜炎46例患者的临床资料进行分析。结果46例结核性脑膜炎好转率为100％。结论结核性脑膜炎临床表现、脑脊液检查、脑CT及颅外结核病灶是结核性脑膜炎的关键。对结脑的早诊早治是结脑预后的关键。     

sCD163在结核性脑膜炎患者脑脊液和外周血中的表达及临床意义

目的探讨sCD163在结核性脑膜炎患者外周血浆及脑脊液中的表达水平及其对临床诊断与预后判断的指导意义。方法收集23例结核性脑膜炎患者,8例病毒性脑膜炎和6例正常人的外周血及脑脊液,ELISA法检测血浆和脑脊液中sCD163的表达,并对脑脊液进行常规生化检查。结果与病毒性脑膜炎和正常人相比,结核性脑膜炎患者外周血及脑脊液中sCD163表达水平明显升高(P0.01),而病毒性脑膜炎患者与头痛患者sCD163水平无明显差异(P0.05)。脑脊液sCD163浓度为89.1 ng/L可作为诊断结核性脑膜炎的切点(cut-off)值,其敏感性和特异性分别为82.6%和93.9%。结核性脑膜炎患者脑脊液中sCD163表达与脑脊液压力和蛋白质含量呈正相关,与脑脊液细胞数无相关性。结论 sCD163在结核性脑膜炎患者外周血和脑脊液中表达上调,并且脑脊液sCD163可作为结核性脑膜炎诊断和预后判断的生物学标志物。     

成人结核性脑膜炎(预后因素)

通常认为结核性脑膜炎的预后与临床严重程度、体温变化和脑脊液情况有关。作者分析32例结核性脑膜炎,讨论了上述因素的预后价值,并提出其他一些有价值的预后因素。本组女15、男17例,年龄19～84(平均46±18)     

影响80例结核性脑膜炎患者近期疗效相关因素分析

结核性脑膜炎是神经系统结核病最常见的类型,由于病变所在的部位和病理变化,致使结核性脑膜炎死亡率高、致残率高,是一种严重的结核病。近年来国内外结核性脑膜炎的发病率及病死率都呈逐渐增高趋势。本研究回顾性分析我院治疗的80例结核性脑膜炎患者的临床资料,探讨临床表现、脑脊液（CSF）生化检查及治疗等因素与患者出院时恢复情况的关系,旨在改善结核性脑膜炎患者预后,提高治愈率,并为临床治疗决策提供科学依据。     

结核性脑膜炎的临床特征及预后影响因素分析

目的分析结核性脑膜炎的临床特征及预后影响因素。方法选择2003年10月—2013年10月在我院住院治疗的结核性脑膜炎患者103例作为研究对象,并以同期病毒性脑膜炎100例、化脓性脑膜炎90例作为对照。观察结核性脑膜炎的临床特征,患者均根据初治与复治情况采用抗结核治疗,跟踪随访(12~18)个月,根据治疗结果分为两组,比较两组患者年龄、性别、疾病分期、抗结核药物方案、初治与复治、鞘内注药与否方面是否存在差异。结果结核性脑膜炎患者脑脊液的细胞数、蛋白、糖和氯化物、腺苷脱氨酶活力与对照组比较,均存在有统计学意义(P0.05);不同治疗结果的结核性脑膜炎患者年龄、疾病分期、初治与复治、鞘内注药与否方面均存在有统计学意义(P0.05)。结论结核性脑膜炎患者脑脊液的细胞数、蛋白、糖和氯化物、腺苷脱氨酶活力均存在异常变化,有利于结核性脑膜炎的诊断,确诊或疑似结核性脑膜炎的患者,均应早期、合理、规律的抗结核治疗,合理的抗结核治疗方案、早期、规律的抗结核治疗、联合鞘内注药可以改善预后。     

结核性脑膜炎脑脊液细胞学的临床研究

目的 探讨脑脊液(cerebrospinal fluid,CSF)细胞学对结核性脑膜炎的诊断及预后评估价值。 方法 对766例结核性脑膜炎、103例化脓性脑膜炎、107例病毒性脑膜炎患者脑脊液分别应用细胞玻片离心沉淀器收集CSF细胞、采用迈-格-姬（May-Gruwald-Giemsa,MGG）染色法、光学显微镜分类计数,对CSF细胞进行动态观察。结果 766例结核性脑膜炎患者中700例CSF细胞学显示为混合细胞型,占91.38%（700/766）,66例显示为淋巴样细胞型,占8.62%（66/766）。103例化脓性脑膜炎患者以中性粒细胞型为主,107例病毒性脑膜炎患者以淋巴细胞型为主。大淋巴样细胞在结核性脑膜炎中的出现率为97.52%(747/766),而化脓性脑膜炎及病毒性脑膜炎则偶见,分别为9.71%（10/103）和14.02%（15/107）;结核性脑膜炎随着病情好转,中性粒细胞、大淋巴样细胞逐渐减少。化脓性脑膜炎随着抗炎治疗,中性粒细胞逐渐减少直至消失;病毒性脑膜炎中性粒细胞一般在24 h内消失。结论 CSF细胞学的类型及动态变化可以作为鉴别3种脑膜炎的依据之一,并对结核性脑膜炎患者的预后评估有参考作用。     

43例结核性脑膜炎的临床分析

目的探讨结核性脑膜炎诊断及其预后。方法1993年5月~2004年12月住院诊断结核性脑膜炎43例临床资料进行回顾性分析。结果43例结核性脑膜炎好转率为83.7%,死亡率为9.3%,自动出院3例。结论临床表现、脑脊液检查、颅外结核灶、CT检查是诊断结脑的关键,早期诊断治疗是改善预后的关键。     

结核性脑膜炎实验室和影像学诊断研究进展

结核性脑膜炎的预后与早期诊断和治疗密切相关,提高结核性脑膜炎早期诊断率是改善预后的关键。本文从实验室检测和影像学检查两方面综述了结核性脑膜炎诊断研究进展。     

结核性脑膜炎并发脑梗死54例回顾分析

目的 探讨结核性脑膜炎并发脑梗死对结核性脑膜炎的诊断和预后评估的价值。方法 分析54例结核性脑膜炎并发脑梗死的临床资料。结果 30例头颅CT异常者中，16例并发脑梗死（8例并发脑积水），占头颅CT异常的53．3％；死亡的5例中，3例为多发脑梗死；留有残疾的11例中，9例为脑梗死所致。结论 当脑脊液改变不典型时，脑梗死、脑积水、脑基底也失去透明或变窄或增宽，脑室质粟粒影，结核瘤及钙化灶等多种CT征象重叠出现时，对结核性脑膜炎的诊断有重要价值。脑梗死和／或脑积水的发生提示预后不良。     

结核性脑膜炎的MRI和CT影像表现及其比较

目的　分析结核性脑膜炎的MRI和CT影像表现,并比较二者对结核性脑膜炎的诊断价值。方法 对42例结核性脑膜炎患者(其中男22例、女20例,年龄从16～45岁之间,平均年龄25岁)均行MRI与CT扫描。所有病例均行自旋回波T1WI、自旋回波或快速自旋回波T2WI及GdDTPA增强T1WI。结果 结核性脑膜炎的MRI和CT影像均可表现为基底池渗出、脑结核瘤,脑积水,脑梗塞等,但MRI尚能观察到脑干、颞叶、视交叉池周围等CT扫描不易显示部位的病变。此外,MRI还能明确显示基底池早期渗出及脑实质异常信号。结论 与CT相比,MRI能进一步提高结核性脑膜炎诊断的准确性及评价其疗效。     

重视结核性脑膜炎的诊断和治疗

结核性脑膜炎是最严重的结核病类型。近年来,在诊断方面研究者探索了改良抗酸染色技术、分子生物学方法、头颅MRI和临床评分系统用于结核性脑膜炎的诊断;在治疗方面着重研究了氟喹诺酮类药物和高剂量利福平用于改善结核性脑膜炎预后的可行性,并且发现应用糖皮质激素能降低结核性脑膜炎患者的病死率。此外,耐药结核性脑膜炎也成为日益突出的临床问题,提示临床医生应重视耐药结核性脑膜炎的诊断与治疗。     

Tuberculous meningitis in Japanese children between 1980-1991]

We evaluated the clinical and laboratory findings of tuberculous meningitis admitted to Tokyo Metropolitan Children's Hospital from 1980 through 1991 retrospectively. They consisted of 26 patients (14 boys and 12 girls), and their age ranged from 4 months to 11 years. Seventeen patients were under 3 years of age. Mortality rate was 4% (1/26), and there were 13 patients with sequelae on discharge from the hospital, and 12 patients without any sequelae. The period to recover normal CSF findings was relatively long. Some cases which did not seem to respond well to chemotherapy at the initial stage, recovered from meningitis without sequelae. This suggests that it is not necessary to change the chemotherapy at the initial few weeks of therapy. The risk factors of poor prognosis were; age less than 2 years, decreased level of consciousness on admission, convulsion, CSF protein more than 70 mg/dl, and CSF glucose less than 20 mg/dl. Tryptophan reaction was not always positive. Chloride in CSF was not so important to diagnose tuberculous meningitis in children. For the proper diagnosis of tuberculous meningitis in children one should consider several factors such as tuberculin skin test, family history, chest X-ray findings and CSF study. BCG was inoculated in six children (three patients were under one year old and the rests were older than 4 years). In three patients under one year old BCG was seemed to be inoculated after Mycobacterium tuberculosis infection, and apparently not effective to prevent tuberculosis meningitis. We conclude that BCG vaccination is necessary in early infancy to prevent tuberculous meningitis.     

4种检测脑脊液结核分枝杆菌法对结核性脑膜炎诊断价值的探讨

目的探讨脑脊液抗酸杆菌涂片、3D、PhaB和PCR检测对结脑的诊断价值。方法检测60例结脑和30例非结脑患者脑脊液涂片、3D、PhaB和PCR阳性率,经统计学处理后,评价4种方法对结脑诊断的灵敏度、特异度。结果结脑组和其他组脑脊液涂片阳性率均为0,3D阳性率分别为23.3%和0,PhaB的阳性率分别是23.3%和26.7%,PCR的阳性率分别是6%和0,4种方法差异无统计学意义。脑脊液3D灵敏度为23.3%,特异度为100%,PhaB灵敏度为23.3%,特异度为73.3%,PCR的灵敏度10%,特异度为100%。结论脑脊液结核分枝杆菌涂片、3D、PhaB和PCR4种检测方法灵敏度低,积极寻找脑脊液结核分枝杆菌的检测方法和提高阳性率是实验室亟需解决的问题。     

Neuromeningeal tuberculosis in northeastern suburbs of Paris. Nineteen cases

SUBJECT: Analyze characteristics of neuromeningeal tuberculosis in the northeastern suburbs of Paris. MATERIAL AND METHOD: Retrospective study of 19 observations between 1988 and 1999. RESULTS: Thirteen cases of meningitis, 3 cases of meningitis associated with a tuberculoma and 3 cases with isolated tuberculoma were described. Young subjects (average age 46.4), foreign born (73.7%) were preferentially affected. Three patients were infected by the human immunodeficiency virus. Weight-loss and weakness (84%), fever (79%), headache (63%) dominate the clinical manifestations. The diagnosis delay was 56.6 days, and the therapeutic time, 8.6 days. The search for acid fast bacilli was positive only in one case on direct examination of the cerebrospinal fluid, whereas the culture was positive in 68.7% of the cases. Cerebral imagery was abnormal in13 patients. Average duration of antituberculous treatment was 13,4 months (range: 9-24). Corticosteroids were associated in 12 patients. Thirteen patients were cured, 3 died and 3 were lost to follow up. CONCLUSION: The characteristics of neuromeningeal tuberculosis are not modified, but the diagnosis delay of the neuromeningeal tuberculosis, which conditions the prognosis, remains significant. The optimal duration of the antituberculous treatment and the conditions of the steroid therapy have to be specified.     

Infarctus cérébral et tuberculose : rapport d'un cas et analyse de la littérature

IntroductionAlthough tuberculous meningitis is an uncommon presentation of tuberculosis, it still remains one of the deadliest forms of this disease. In this context, the occurrence of a cerebral infarct is an aggravating factor.ObservationA 48-year-old Asian man presented himself in the emergency room for dysarthria and dysphagia of progressive onset. Cerebral CT showed a recent ischemic defect of the right internal capsule. Lumbar puncture showed meningitis with low sugar levels. Pulmonary micronodules on the thoracic CT suggested tuberculosis, which was confirmed by a broncho-alveolar lavage. Anti-tuberculosis treatment and early corticosteroid resulted in an improvement of the patient's state.ConclusionCerebral infarctions in patients with tuberculous meningitis are events that cannot be underestimated in terms of frequency or severity. Their poor prognosis is partly the result of insufficiently defined management, which combines anti-tuberculosis treatment and early corticosteroid therapy.     

A review of tuberculous meningitis in a Canadian pediatric hospital

Tuberculous meningitis is a disease associated with high morbidity and mortality. Experience with this disease at the Hospital for Sick Children in Toronto was reviewed to determine whether changes in prognosis have occurred in the past decade. All patients from whom the organism was recovered from the cerebrospinal fluid, or who had a positive Mantoux test in association with a compatible history, were included. Thirteen patients were identified from 1978 to 1989. The median age was six years (range 11 months to 17.5 years). Nine patients were born in Canada, but all except one were members of recently immigrant families. History of close contact with an adult with tuberculosis, or travel to an endemic area in the preceding six months, was present in seven cases. All patients had clinical manifestations and mild pleocytosis with elevated protein content in the cerebrospinal fluid. Patients were all diagnosed within 20 days after admission (median one day). Computed tomography scan of the head was abnormal in all patients within three weeks of admission. No patient died, although long term sequelae developed in five. The prognosis of tuberculous meningitis has improved in the past decade. Although a specific reason for this improvement cannot be definitively stated, earlier diagnosis and better chemotherapy may contribute.     

糖皮质激素在艾滋病免疫重建炎性综合征中的应用分析

目的探讨分析糖皮质激素在艾滋病（AIDS）免疫重建炎性综合征（IRIS）中的应用价值。方法回顾性分析AIDS高效抗逆转录病毒治疗（HAART）过程中发生IRIS而使用糖皮质激素治疗的19例患者的临床资料。结果 IRIS并发肺结核10例、结核性胸膜炎4例、颈淋巴结结核2例、结核性脑膜炎1例、隐球菌脑膜炎2例。表现为持续发热19例（100%）,头痛呕吐3例（15.8%）。使用激素治疗前均给予非甾体类抗炎药物对症处理无效,经糖皮质激素治疗后好转。结论糖皮质激素可改善IRIS并发结核病、隐球菌脑膜炎的临床症状,提高患者治疗的依从性。     

15例妊娠并发结核病孕产妇的临床分析

收集重庆市公共卫生医疗救治中心结核科2017年1月1日至2019年9月30日期间收治的15例妊娠并发结核病孕产妇的临床资料,对其临床表现、就诊延迟情况、影像学表现、免疫应答状况、治疗效果、胎儿结局等进行总结。(1)临床表现:患者以发热、乏力和咳嗽为主,结核性脑膜炎患者以头痛为主要临床表现。(2)就诊延迟情况:12例患者存在不同程度就诊延迟,最短延迟时间20d,最长延迟时间252d,中位就诊延迟时间为78d。(3)影像学表现:胸部CT扫描4例患者可见双肺多叶段斑片状渗出影或空洞影,12例见双肺弥漫性粟粒、小结节状影,10例并发单侧或双侧胸腔积液或胸膜增厚。11例并发结核性脑膜炎患者行头颅MRI,显示脑实质结节、斑片状病灶9例,脑膜增厚8例,脑组织水肿2例,脊髓膜增厚1例。(4)免疫应答:10例CD4 ⁺ T淋巴细胞计数降低,9例CD8 ⁺ T淋巴细胞计数降低,11例CD4 ⁺/CD8 ⁺比值下降。(5)治疗效果:14例患者经抗结核药物治疗后病情好转,1例因重症结核性脑膜炎住院时间延长。(6)胎儿结局:自然受孕胎儿10例,流产1例,死产1例,分娩8例(死于结核性脑膜炎患儿2例,健康胎儿6名);辅助生殖技术受孕胎儿7例,流产2例,分娩5例(健康胎儿3例,死于结核性脑膜炎患儿2例)。综上所述,妊娠并发结核病孕产妇免疫应答低下,并发血行播散性肺结核多见;结核分枝杆菌易经血液播散引起肺外结核,以结核性脑膜炎常见。妊娠并发结核病孕产妇就诊延迟现象严重,及时规范的治疗可使孕产妇和胎儿获益。