64例不典型结核性脑膜炎临床诊断和治疗分析

目的　探讨不典型结核性脑膜炎(结脑)的临床分类、诊断和治疗方法。方法 回顾性总结分析68例不典型结脑临床特点、诊断依据,采用3HS(E)RZ/9HRZ化疗方案,并用地塞米松、降颅压治疗。结果 68例不典型结脑分为脑脊液改变不典型、脑脊液和临床表现均不典型两类;治疗结果67例存活,死亡1例,无明显后遗症。随访2年以上者64例。结论 不典型结脑诊断参考:(1)活动性肺结核表现;(2)不典型脑脊液改变或/和不典型结脑临床表现;(3)抗结核试验治疗有效;(4)除外非结脑疾病;(5)脑脊液PPD抗体阳性、腺苷脱氨酶(ADA)增高;(6)CT或MR符合结脑影像;(7)病理显示结核样改变或脑脊液检出抗酸杆菌;具备1~6项中3项或第7项可诊断。采用HS(E)RZ四联12个月化疗,安全、有效。

Study on the clinical diagnosis treatment of untypical tuberculosis meningitis

Objective To study the clinical diagnosis and treatment of untypical tuberculosis meningitis(TBM). Method To analysis the clinical characteristics and the diagnosis basis on the 68 untypical TBM casesrespectively.3HS(E)RZ/9HRZ treatment regimen were adapted,DXM were used as well as to lower the head pressure. Results Sixty-eight cases were divided into two categories.Among them,67 cases are alive,one died,and no sequel left.Furthermore,64 cases have been followed up for over 2 years. Conclusions Diagnosis of untypical TBM can be based on the basis of following manifestations:(1)Manifestations of active pulmonary tuberculosis.(2)Changes of untypical cerebrospinal fluid(CSF) or/and manifestations of untypical TBM.(3)The experiment antituberculotic therapy is effect.(4)Non-TBM diseases can be excepted.(5)PPD antibody in CSF is positive,ADA in CSF is high.(6)Images of head CT and MRI accord with TB changes.(7)Tuberculotical mycobacterium can be found in CSF.If there are 3 items in the anterior 6 or possesses the 7th items alone,the untypical TBM can be determined,and to adapt HS(E)RZ that four drugs are union as a twelve month chemical therapy will be safe and effective.