结核性脑膜炎伴意识障碍患者的预后影响因素分析

目的 分析结核性脑膜炎(tuberculous meningitis, TBM)伴意识障碍患者的预后影响因素。方法 回顾性分析2013年1月至2019年1月长沙市中心医院112例临床诊断为TBM伴意识障碍患者的资料,其中21例(18.8%)为确诊TBM患者,84例(75.0%)为高度可能的TBM患者,7例(6.2%)为可能的TBM患者。根据患者出院时改良Rankin量表(mRS)评分情况,将患者分为预后良好组48例(42.9%),预后不良组64例(57.1%)。预后良好组男性24例,中位年龄M(Q₁,Q₃)]18.50(5.31,33.75)岁,中位病程20.00(11.25,30.00)d。预后不良组男性20例,中位年龄27.00(3.06,49.75)岁,中位病程15.00(10.00,20.00)d。采用logistic回归分析影响患者预后不良的影响因素。结果 单因素分析结果显示,住院时间(Z=-1.982,P=0.048)、性别(χ ²=4.043, P=0.044)、疾病分期(χ ²=17.733, P=0.000)、抽搐(χ ²=8.054, P=0.005)、低钠血症(χ ²=9.481, P=0.002)、脑水肿(χ ²=4.386, P=0.036)、脑积液(χ ²=5.992, P=0.014)对TBM伴意识障碍患者预后不良有一定影响。logistic回归分析显示,低钠血症(P=0.043, OR=2.784, 95%CI:1.034~7.495)、疾病分期为Ⅲ期(P=0.002, OR=6.855, 95%CI:2.001~23.480)、脑水肿(P=0.030, OR=3.491, 95%CI:1.132~10.768)是预后不良的危险因素。 结论 低钠血症、疾病分期为Ⅲ期、脑水肿是TBM伴意识障碍患者的预后不良的影响因素。

Analysis of influencing factors for prognosis of tuberculous meningitis patients with consciousness disorder

Objective To analyze influencing factors for prognosis of tuberculous meningitis (TBM) with disturbance of consciousness.Methods Clinical data of 112 patients with consciousness disorder and TBM in Changsha Central Hospital from January 2013 to January 2019 was retrospectively analyzed. 21 (18.8%) patients were definite TBM cases while 84 (75.0%) were probable TBM cases, and 7 (6.2%) were possible TBM cases. According to their scores of modified Rankin scale (mRS) assessed at discharge from hospital, patients were divided into 48 (42.9%) patients with good prognosis and 64 (57.1%) patients with poor prognosis. There were 24 males with good prognosis. The median age was 18.50 (5.31, 3.75) years and the median duration of disease was 20.00 (11.25, 30.00) days. There were 20 males in the poor prognosis group, with a median age of 27.00 (3.06, 49.75) years and a duration of 15.00 (10.00, 20.00) days. Logistic regression analysis was used to analyze influencing factors of poor prognosis of patients.Results Univariate analysis showed that hospital stay (Z=-1.982, P=0.048), sex (χ ²=4.043, P=0.044), disease stage (χ ²=17.733, P=0.000), convulsion (χ ²=8.054, P=0.005), hyponatremia (χ ²=9.481, P=0.002), brain edema (χ ²=4.386, P=0.036), hydrocephalus (χ ²=5.992, P=0.014) were influencing factors for poor prognosis among TBM patients with impaired consciousness. Multivariate analysis showed that hyponatremia (P=0.043, OR=2.784, 95%CI:1.034-7.495), stage Ⅲ of consciousness disturbance (P=0.002, OR=6.855, 95%CI:2.001-23.480), encephaledema (P=0.030, OR=3.491, 95%CI:1.132-10.768) were risk factors for poor prognosis. Conclusion Hyponatremia, stage Ⅲ of disease and brain edema are the main influencing factors for poor prognosis for TBM patients with disturbance of consciousness.