结核性脑膜炎神经体征转归的相关因素分析

目的：评价影响结核性脑膜炎神经功能缺失体征转归的临床因素。方法：对我院神经内科1998～2003年收治的45例入院时有神经功能缺失体征的结核性脑膜炎患者的临床、生化特征、治疗1a后的神经功能恢复情况进行观察研究。结果：45例患者中神经功能缺失体征完全或部分恢复22例（48．9％），加重或无变化者23例（51．1％）。加重或无变化病例中14例（31．1％）仍留有明显神经系统残疾，9例（20．0％）死亡。多因素统计结果显示，患者开始抗结核治疗时间与神经功能缺失体征转归密切相关（OR=1．843．P＜0．05），其他变量（性别、年龄、肺结核病史、脑积水、脑梗死、脑脊液自细胞数、脑脊液蛋白含量、激素应用等）的差异无显著性。结论：患者发病后开始抗痨治疗时间是影响本组患者神经功能缺失体征转归的重要因素．因此延误诊断和治疗仍是目前引起结核性脑膜炎神经系统残疾和死亡的重要原因。

The Prognosis Analysis of Neurological Deficit Signs in Tuberculous Meningitis

Objective:To evaluate clinical factors to effect the prognosis of neurological deficit signs in tuberculous meningitis(TBM).Method:45 TBM patients with focal neurological signs seen between 1998 and 2003 in our hospital were studied in clinical,biochemical features and prognosis.Results:Of 45 TBM patients with neurological deficit signs,22 cases(48.9%) were partial or complete recovery,23 patients(51.1%) had poor outcome in which 9(20.0%) died and 14(31.1%)had substantial neurological morbidity on one year after treatment.Multivariate analysis revealed a significant correlation of the time to initiating tuberculous treatment(OR=1.843,P<0.05) with poor morbidity and mortality.The other factors(age,sex,extrameningeal tuberculosis,hydrocephalus,cerebral infarct,CSF white blood count,CSF protein level,steroids) were not statistically significant.Conclusion:The results emphasise the importance of early diagnosis and the prompt anti-tuberculosis therapy for tuberculous meningitis.Delay in treatment either results in death,or substantial neurological morbidity.