222例儿童结核性脑膜炎的临床特征及其预后影响因素分析

目的 探讨分析儿童结核性脑膜炎(tuberculous meningitis, TBM)的临床特征及其预后影响因素。方法 参照TBM诊断标准纳入2015年1月至2019年1月重庆医科大学附属儿童医院收治的222例TBM患儿,通过单因素和多因素logistic回归分析,评估患儿临床各种指标及因素对预后转归(治疗后6个月)的影响。结果 222例患儿中,129例(58.11%)患儿预后良好,93例预后差,其中7例死亡。男童117例(52.70%),中位年龄6岁,其中<5岁者107例(48.20%);108例(48.65%)有与结核病患者的密切接触史;110例(49.55%)确诊时长>21 d;137例(61.71%)患儿存在营养不良;205例(92.34%)结核病灶累及2个及以上部位或脏器,并以并发肺结核最常见[200例(90.09%)];病情分期(按照GCS评分)为Ⅱ期和Ⅲ期的患儿有144例(64.87%)。多因素logistic回归分析显示,脑脊液葡萄糖及氯化物含量高是患者预后良好的保护因素[OR(95%CI)=0.444(0.257~0.769);OR(95%CI)=0.914(0.854~0.980)],两者含量越高预后不良的发生率越低;而意识改变、性格改变、脑积液和梗阻性脑积液的高发生率则是患者发生不良预后的危险因素[OR(95%CI)=6.969(2.283~21.277);OR(95%CI)=2.531(1.105~5.796);OR(95%CI)=3.429(1.546~7.604);OR(95%CI)=10.233(1.059~98.886)]。结论 TBM患儿预后差的发生率和死亡率均较高,积极寻找结核病密切接触史和其他脏器结核感染证据有助于TBM的早期诊断,改善患儿营养不良、降低脑积液的发生率则有助于改善TBM患儿的预后转归。

Analysis of clinical features and influencing factors of prognosis in 222 children with tuberculous meningitis

Objective To explore clinical features and influencing factors of prognosis in children with tuberculosis meningitis (TBM). Methods According to the diagnostic criteria, 222 TBM children from the Children’s Hospital affiliated to Chongqing Medical University from January 2015 to January 2019 were included. Univariate analysis and multivariate logistic regression analysis were used to evaluate the clinical indicators and influencing factors of prognosis in TBM children. Results Of the 222 cases, 129 (58.11%) had good prognosis, while 93 had bad prognosis, of whom 7 died; 117 (52.70%) were boys, 107 (48.20%) aged <5 years with the median of 6 years; 108 (48.65%) cases had a history of close contact with TB patients, duration of the diagnosis were over 21 days in 110 cases (49.55%) and 137 (61.71%) cases suffered malnutrition;in 205 cases (92.34%), tuberculosis lesions were found in 2 or more parts or organs, and pulmonary tuberculosis were the most common complication (n=200, 90.01%); 144 cases (64.87%) were at stage Ⅱ and stage Ⅲ TBM (according to GCS score). By multivariate logistic regression analysis, it was found that high cerebrospinal fluid (CSF) glucose and chloride were protective factor of the prognosis of TBM children (OR (95%CI)=0.444 (0.257-0.769);OR (95%CI)=0.914 (0.854-0.980)),the higher the CSF glucose and chloride, the better the prognosis. High incidence rates of consciousness disturbance, personality change,hydrocephalus and obstructive hydrocephalus were the risk factors of prognosis (OR (95%CI)=6.969 (2.283-21.277);OR (95%CI)=2.531 (1.105-5.796);OR (95%CI)=3.429 (1.546-7.604);OR (95%CI)=10.233 (1.059-98.886)). Conclusion Both the poor prognosis and mortality were high in TBM children. The detection of history of close contact with TB patients and tuberculosis in some other organs would help to diagnosis at early stage. Improvement of malnutrition and decreasement of cerebral effusion were good for prognosis.