影响结核性脑膜炎早期诊断的相关因素分析

Influence factors of early diagnosis of tuberculous meningitis

目的通过对结核性脑膜炎病例的统计和分析，提高对结核性脑膜炎鉴别诊断的认识，为临床诊治结核性脑膜炎提供帮助。方法回顾性分析汕头大学医学院附属粤北人民医院2003年1月～2011年12月临床诊断的172例“结核性脑膜炎”病例和633例疑似病例的临床资料，两组资料进行单因素检验后，用非条件logistic模型进行多元分析。结果多因素结果筛选出头痛发热、脑积水或脑梗死、脑脊液压力升高、糖和氯化物同时降低、腺苷脱氨酶（ADA）升高是结核性脑膜炎确诊的独立影响因素。结论结核性脑膜炎早期由于临床症状、脑脊液及影像学表现等不典型，极易误诊．应针对其重点表现因素进行诊断，一旦确诊应尽早给予抗结核治疗，改善预后。

Objective To improve differential diagnosis of tuberculosis meningitis （TBM） and anti-tuberculosis treatment through analyzing the patient of TBM. Methods 172 patients with TBM and 633 suspected patients were retrospectively analyzed from January 2003 to December 2011 in hospital. Multiple factor analysis with non conditional Logistic model was used after single factor test between TBM and suspected patients. Results The independent factors of early diagnosis of TBM were as follows： fever, headache, hydrocephalus, cerebral infarction, cerebrospinal fluid pressure rise, sugar and chloride reduce and ADA rise. Conclusion Because of atypical features of early TBM, which can easily lead to misdiagnose. Therefore, using independent factors is very important. To improve the prognosis, anti-TB treatment should be given as soon as diagnosis.