老年结核性脑膜炎的临床研究

对经脑脊液（ＣＳＦ） 和ＣＴ证实为脑积水的老年结核性脑膜炎患者（ＯＴＢＭ） ４２ 例进行回顾性分析， 并与同期无脑积水的ＯＴＢＭ ３９ 例对照， 以研究ＯＴＢＭ 的ＣＳＦ变化、影像学改变与脑积水形成的关系及其预后。发现ＯＴＢＭ临床症状、ＣＳＦ变化不典型， 基础疾病多， 病死率较高 （２８．５７％ ）， 与对照组比较有显著差异 （Ｐ＜ ０．０５）。结果表明：脑膜纤维蛋白渗出、增殖和老年性脑室变窄是形成脑积水的直接因素。ＣＳＦ指标的动态检测对脑积水的早期诊断、疗效判断、预后评估具有重要价值。早期规范抗痨， 早用激素， 对减轻脑膜炎症与脑积水、提高治愈率至关重要

The Clinical Study on the Aged Tuberculous Meningitis

To study the relationship am ong the changes ofcerebralspinalfluid (CSF) and im aging and the developm ent of hydrocephalus in the aged tuberculous m eningitis (OTBM) and its prognosis, a retrospective analysis w as conducted on 42 patients w ith OTBM com plicated w ith hydrocephalus dem onstrated by CSF test and CT scan. The results w ere com pared w ith those in 39 cases w ithout hydrocephalus atthe sam e tim e. The clinicalsym ptom s and the change ofCSFin OTBM w ere nottypical, and as com pared w ith the controlgroup, there w ere m uch m ore basical diseases and a higher m ortality (28.57 % , P< 0.05) . Fibrin oozed from m eninges, m eninges proliferation and senile cerebral-ventricle narrow ness w ere the direct factors of the developm ent of hydrocephalus. The dynam ic m onitoring ofCSF indexes m ight play an im portant role in the early diagnosis, evaluation of therapeutic effects and prognosis. In order to relieve m eninges inflam m ation and hydrocephalus and to im prove the cure rate it is very im portant to com battuberculosis standardly and utilize corticosteroid as early as possible.