老年结核性脑膜炎的临床研究

The Clinical Study on the Aged Tuberculous Meningitis

对经脑脊液（ＣＳＦ） 和ＣＴ证实为脑积水的老年结核性脑膜炎患者（ＯＴＢＭ） ４２ 例进行回顾性分析， 并与同期无脑积水的ＯＴＢＭ ３９ 例对照， 以研究ＯＴＢＭ 的ＣＳＦ变化、影像学改变与脑积水形成的关系及其预后。发现ＯＴＢＭ临床症状、ＣＳＦ变化不典型， 基础疾病多， 病死率较高 （２８．５７％ ）， 与对照组比较有显著差异 （Ｐ＜ ０．０５）。结果表明：脑膜纤维蛋白渗出、增殖和老年性脑室变窄是形成脑积水的直接因素。ＣＳＦ指标的动态检测对脑积水的早期诊断、疗效判断、预后评估具有重要价值。早期规范抗痨， 早用激素， 对减轻脑膜炎症与脑积水。

To study the relationship am ong the changes ofcerebralspinalfluid (CSF) and im aging and the developm ent of hydrocephalus in the aged tuberculous m eningitis (OTBM) and its prognosis, a retrospective analysis w as conducted on 42 patients w ith OTBM com plicated w ith hydrocephalus dem onstrated by CSF test and CT scan. The results w ere com pared w ith those in 39 cases w ithout hydrocephalus atthe sam e tim e. The clinicalsym ptom s and the change ofCSFin OTBM w ere nottypical, and as com pared w ith the controlgroup, there w ere m uch m ore basical diseases and a higher m ortality (28.57 % , P< 0.05) . Fibrin oozed from m eninges, m eninges proliferation and senile cerebral-ventricle narrow ness w ere the direct factors of the developm ent of hydrocephalus. The dynam ic m onitoring ofCSF indexes m ight play an im portant role in the early diagnosis, evaluation of therapeutic effects and prognosis. In order to relieve m eninges inflam m ation and hydrocephalus and to im prove the cure rate it is very im portant to com battuberculosis standardly and utilize corticosteroid as early as possible.