40例结核性脑膜炎早期诊断方法探讨

目的 :探讨结核性脑膜炎 (TBM)患者早期诊断方法。方法 :用结核杆菌PCR检测法以及ELLSA法检测结核抗体两种方法综合诊断。结果 :临床确诊结核性脑膜炎患者 ,脑脊液 (CSF)结核杆菌PCR的阳性率达 85 % ,结核抗体阳性率达 80 %。结论 :结核抗体、结核杆菌PCR检测可以作为结核性脑膜炎患者确诊的重要指标     

40例结核性脑膜炎早期诊断方法探讨

目的：探讨结核性脑膜炎（TBM）患者早期诊断方法。方法：用结核杆菌PCR检测法以及ELISA法检测结核抗体两种方法综合诊断。结果：临床确诊结核性脑膜炎患者,脑脊液（CSF）结核杆菌PCR的阳性率达85％,结核抗体阳性率达80％。结核：结核抗体、结核杆菌PCR检测可以作为结核性脑膜炎患者确诊的重要指标。     

结核蛋白芯片检测脑脊液中抗体对结核性脑膜炎诊断价值

目的探讨结核分枝杆菌蛋白芯片检测脑脊液中结核抗体诊断结核性脑膜炎的应用价值。方法应用结核蛋白芯片检测30例临床诊断结核性脑膜炎患者脑脊液及血清标本,30例非结核性脑膜炎患者脑脊液标本,并对实验结果进行分析评价。结果结核芯片法检测脑脊液敏感性、特异性、阳性预测值、阴性预测值、约登指数分别为63.33%、96.67%、95.00%、72.50%、60.00%,结核芯片法检测血清性为66.67%。比较结脑组脑脊液及血清阳性率,差异无统计学意义(χ2=0.073,P=0.787,P>0.05)。结论结核蛋白芯片检测脑脊液可以成为结核性脑膜炎诊断的辅助检查,且具有快速、简便、经济等优点。     

老年结核性脑膜炎临床分析

目的分析老年结核性脑膜炎(简称结脑)的临床特点,以便于早期诊断及治疗。方法观察老年结核性脑膜炎(观察组,18例)的起病特点、临床症状、脑脊液改变及辅助检查,并与成年结脑患者(对照组,24例)进行对照分析。结果老年结脑患者临床起病多以亚急性和慢性起病,临床误诊较多见,症状及脑脊液改变较不典型,脑脊液改变与对照组比较大多无显著性差异;部分病人出现偏瘫和智力下降,观察组临床诊断符合比例仅为8/18。结论老年结核性脑膜炎临床诊断困难,更容易误诊,错误的诊断和治疗的延误会导致致命性的后果,应对该病保持高度的警惕,对疑诊结脑患者及早给予常规试验性抗结核治疗是必要的。     

结核性脑膜炎的磁共振成像诊断

目的 探讨结核性脑膜炎(TBM)的MRI表现及其诊断价值。方法 15例临床确诊为TBM病人的MR平扫和Gd—DTPA增强扫描表现,进行了回顾性分析。结果 所有病人的MR图像均显示异常病变,包括粟粒性结节3例,脑膜渗出9例．脑积水8例,脑梗死5例和结核瘤6例。结论 MR成像特别是增强扫描是TBM最有效的诊断方法。     

65例结核性脑膜炎的CT与临床分析

本文总结了６５例结核性脑膜炎的临床资料和ＣＴ改变，将ＣＴ改变分为６类：①脑积水；②脑底部增生性脑膜炎；③血管炎所致的脑梗塞④脑结核瘤；⑤粟粒型脑结核；⑥脑萎缩。根据ＣＴ改变，就诊断和治疗的有关问题做了讨论。     

结核性脑膜炎50例脑脊液检查结果分析

我科白2005—01～2009—06对50例结核性脑膜炎患者的脑脊液（CSF）进行检测,结果报告如下。     

脑脊液腺甘脱氨酶及结核抗体测定在结核性脑膜炎中的诊断价值

结核性脑膜炎(结脑)是常见的中枢神经系统感染性疾病，在临床上常见。但在诊断上尚有一定的困难。现将我院2年内检测100例腺甘脱氨酶(ADA)与结核抗体检测结果报道如下。     

Ischemic Stroke in the Setting of Tuberculous Meningitis

The clinical syndrome of tuberculous (TB) meningitis leading to ischemic strokes is rarely seen today in immunocompetent adults native to North America. This entity is also notoriously difficult to diagnose because the presenting symptoms are often nonspecific. The authors describe a case of a man with TB meningitis which progressed to recurrent ischemic cerebral infarcts.     

免疫斑点法早期诊断结核性脑膜炎实验研究

目的建立免疫斑点法检测结核杆菌抗原,探讨应用免疫斑点法对早期快速诊断结核性脑膜炎的应用价值。方法以D（λ）值（取对数Log）为纵坐标,抗原浓度（取对数Log）为横坐标,绘制标准曲线,求出回归方程。结果确定兔抗结核杆菌PPD多克隆抗体浓度1∶200（20μg/mL）、通用型酶标抗体浓度1∶10为最佳反应浓度组合;回归方程Y=0.9982X-0.9229,P〈0.001。最小结核杆菌抗原检出量为3.65ng/mL。结论此法灵敏度高、特异性强,简便、快捷,不需特殊仪器,结果可保存,适合我国国情,适于在广大临床实验室推广应用。     

运用PCR及ABC－ELISA法早期诊断结核性脑膜炎的评价

收集了４１例结核性脑膜炎（结脑）患者和３０例非结脑患者脑脊液，运用ＰＣＲ法扩增结核蛋白抗原Ｂ上ＤＮＡ序列４１９ｂｐ片段，用ＡＢＣ－ＥＬＩＳＡ检测抗结核蛋白抗体。结脑组ＰＣＲ阳性率７５．７％（３１／４１），抗结核抗体阳性率６３．５％（２６／４１）；对照组ＰＣＲ全部阳性，抗结核抗体阳性率１３．３％。ＰＣＲ阳性可在发病第２天查到且在治疗６个月时仍可见ＰＣＲ阳性。随病程延长抗体阳性率上升。运用ＰＣＲ及ＡＢＣ－ＥＬＩＳＡ法早期诊断结脑快速而敏感，两法同时应用可提高阳性率。     

PCR DNA扩增、抗原、特异性抗体联合检测对结核性脑膜炎的诊断研究

应用多聚酶链反应技术（ＰＣＲ）体外扩增脑脊液中结核分枝杆菌ＤＮＡ，酶斑免疫结合技术检测结核杆菌蛋白抗原及ＡＢＣ－ＥＬＩＳＡ法检测相应抗体联合检测诊断结核性脑膜炎，阳性率分别为：８３．７％（３６／４３），７６．７％（３３／４３），７４．４％（３２／４３）。讨论三者间发病不同期的关系，三者有阳性交叉现象。     

结核性脑膜脑炎的综合治疗

目的探讨结核性脑膜脑炎(TBM),尤其是重症TBM的诊断及综合治疗。方法对32例结核性脑膜脑炎的临床表现、客观检查及抗结核化疗方案等综合治疗进行总结分析。结果 32例病例中死亡3例,治愈29例,其中一次性治愈24例,复发后再次治愈5例;32例全部行静脉及鞘内注射抗痨药物等综合治疗,其中行侧脑室引流5例,行脑室腹腔引流术3例。结论 TBM的早期诊断及综合治疗是改善预后、降低死亡率的重要因素。     

Tuberculous meningitis presenting as mesencephalic infarction and syringomyelia

Cerebral ischaemia is a serious complication of tuberculous meningitis (TBM) with the anterior circulation most commonly affected. Acute syringomyelia is a very rare complication of TBM. Here, we report an unusual presentation of TBM with a third nerve palsy as a result of posterior circulation stroke as well as a syringomyelia.     

脑脊液中抗BCG抗体分泌细胞测定对结核性脑膜炎鉴别诊断价值的研究

用酶联免疫斑点(Elispot)法，将BCG作为抗原，对16例结核性脑膜炎33例次脑脊液中淋巴细胞分离培养，从体外检测BCG特异性IgG抗体分泌细胞，结果表明总阳性率为91．7％，对照组(其它颅内炎症)18例共22例次检测无1例阳性。提示采用本法对结核性脑膜炎进行诊断具有特异性。     

结核性脑膜炎36例分析

目的:分析结核性脑膜炎的临床及脑脊液特点。方法:回顾分析我院近四年来住院初治结核性脑膜炎患者36例的临床及实验室资料。结果:脑脊液压力升高30例(180～280mmH2O,平均208.3±29.1mmH2O),发生率83%,白细胞计数升高36例,发生率100%,糖降低34例,发生率94%,氯化物降低34例,发生率94%,蛋白升高35例(1000～5000mg/L,平均2380±149.7mg/L),阳性率97%,脑CT异常8例,阳性率31%,表现为基底池渗出,脑积水,脑梗塞等,胸部平片提示肺结核21例,占62%。结论:结核性脑膜炎临床表现复杂,神经系统并发症发生率47%,患者的临床表现、脑脊液检查和肺外结核感染是诊断结核性脑膜炎的重要线索。     

HHH Regime for Arteritis Secondary to TB Meningitis: A Prospective Randomized Study

Background  Tuberculous meningitis (TBM) is a fairly common, debilitating disease and is often complicated by arteritis resulting in brain infarction. Few treatment regimes specifically address this condition. Hypervolemia–hypertension–hemodilution (HHH) regime is known to be effective for treatment of vasospasm complicating subarachnoid hemorrhage. We studied the efficacy of HHH regime in patients with TBM with arteritis using a prospective, randomized study design. Patients and Methods  Patients diagnosed to have TB meningitis by clinical, CSF, and imaging findings were evaluated for arteritis, which was recognized by presence of focal neurologic deficits with or without corresponding focal hypodensities on brain CT scan. Patients with deficits of <96 h were randomized to HHH or conservative treatment. All patents received four-first-line anti-TB drugs and Inj.dexamethasone. HHH therapy was administered over 3–9 days. Neurologic status and modified Rankin score were noted serially and at discharge. Results  Seven patients received HHH and 5, conservative treatment. All had hemiparesis with power 0–3/5. Median GCS was worse in HHH group (11 vs. 13). In the HHH group, 6/7 improved in motor power, and 5/7 in sensorium. In the control group, 3/5 improved in motor power and 3/5 in sensorium. Four patients died in each group. Conclusion  HHH therapy is safe and may be beneficial in the management of patients with infective arteritis secondary to TBM. Further study in a larger group with improved monitoring of cerebral circulation is indicated.