结核性脑膜炎脑脊液中糖浓度与临床表现关系的研究

Clinical investigation of glucose concentration in cerebrospinal fluid as a presenting feature of tuberculous meningitis

目的探讨脑脊液(CSF)中糖浓度<1.0mmol/L结核性脑膜炎患者的临床特点,治疗和预后。方法回顾分析2001年11月至2006年5月在华中科技大学附属同济医院临床确诊为结核性脑膜炎114例患者的临床资料,按CSF中糖浓度是否低于1.0mmol/L分成两组,并对两组患者的临床症状、体征、CSF各项指标,影像学结果以及预后情况进行分析比较。结果CSF中糖浓度低于1.0mmol/L的结核性脑膜炎患者可能主诉症状持续时间(P=0.007),病情程度,共济失调(P<0.01),意识模糊(P<0.01),人格改变(P=0.014),失禁(P=0.030),小脑性共济失调(P<0.01),Glasgow昏迷等级(P=0.023),新发脑梗死(P<0.01)和1年后的预后不良(P<0.01)较对照组严重。结论结核性脑膜炎CSF中糖浓度低于1.0mmol/L的患者入院病情较重,可能遗留更多的持续性神经功能缺损。

Objective To investigate the clinical feature, treatment and prognosis of the tuberculous meningitic patients whose glucose concentration in cerebrospinal fluid were 〈 1.0 mmol/L. Methods We reviewed 114 patients diagnosed as TBM and assigned them into two groups according to glucose level in cerebrospinal fluid. The reference level of glucose was 1.0 mmol/L. The clinical symptoms and signs, parameters of cerebrospinal fluid, neuroradiological manifestations and prognosis features of patients with glucose level in cerebrospinal fluid lower than 1.0 mmol/L were compared to those with glucose level in cerebrospinal fluid higher than 1.0 mmol/L. Results The glucose concentration in cerebrospinal fluid lower than 1.0 mmol/L was associated with a longer duration of presenting symptoms （P = 0. 007 ）, ataxia （P 〈 0. 01 ） , conscious disturbance （ P 〈 0. 01 ） , personality change （ P = 0. 014 ）, incontinence （ P = 0. 030 ）, cerebellum ataxia （ P 〈 0. 01 ）, Glasgow score （ P = 0. 023 ）, new infarct （ P 〈 0.01 ） and poor outcome at one year （ P 〈 0. 01 ）, Conclusion The glucose concentration in cerebrospinal fluid lower than 1.0 mmol/L in TBM patients may be a poor prognostic marker associated with severe TBM and a higher risk of much more prolonged neurological deficiencies.