系统性红斑狼疮合并结核性脑膜炎15例临床分析

Clinical Analysis of 15 Cases Systemic Lupus Erythematosus with Tuberculous Meningitis Patients

目的探讨系统性红斑狼疮（SLE）合并结核性脑膜炎的诊断及鉴别诊断。方法对15例SLE合并结核性脑膜炎患者的临床表现、实验室检查、治疗及转归进行回顾性分析。结果15例患者在合并结核性脑膜炎前均长期服用激素。血清白蛋白下降6例（6／15），低钠低氯血症6例（6／15），蛋白尿12例（12／15）。脑脊液压力升高9例（9／15），蛋白定量升高15例（15／15），糖降低14例（14／15），氯化物降低13例（13／15），自细胞计数升高13例（13／15）。腺苷脱氨酶定量升高7例（7／10），ATA—IgG阳性5例（5／15），聚合酶链反应阳性2例（2／8），抗酸杆菌涂片阳性0例（0／15），抗酸杆菌培养阳性2例（2／15）。结论脑脊液中发现抗酸杆菌是确诊SLE合并结核性脑膜炎的可靠依据，但阳性率低。对无病原微生物证据的SLE患者是否合并结核性脑膜炎的诊断需要综合判断。

Objective To investigate the diagnosis and differential diagnosis about systemic lupus erythematosus（SLE） with tuberculous meningitis patients. Methods 15 cases of SLE with tuberculous meningitis, to review analysis its clinical manifestations,laboratory examination, treatment and prognosis. Result All of 15 patients, before complicated tuberculous meningitis,they are use hormone drugs the long-term. 6 cases of serum ALB decreased （6/15） , low sodium chloride hyperlipidemia in 6 cases （6/15）, 12 cases of proteinuria（12/15）. Increased cerebrospinal fluid pressure in 9 cases（9/15） ,increased protein 14 cases（14/15）, 15 cases of reducing sugar（ 15/15 ） ,13 cases of lower chloride（ 13/15 ） ,elevated white blood cell count 13 cases （ 13/15 ）. ADA quantitative increase in seven cases （ 7/10 ）, ATA-IgG of 5 cases are positive （ 5/15 ）, PCR of 2cases are positive（ 2/8 ） , acid-fast bacilli smear-positive 0 eases （ 0/15 ）, culture-positive acid-fast bacilli in 2 cases（2/15 ）. Conclusion Cerebrospinal fluid acid-fast bacilli found in SLE is diagnosed tubercular meningitis combined a solid basis, but the positive rate is low. Evidence of non-pathogenic microorganisms in patients with SLE whether or not complicated tuberculous meningitis need to a comprehensive determine