结核性脑膜炎的诊断和治疗

Diagnosis and Treatment of Tuberculous Meningitis

结核性脑膜炎(TBM)是一种严重的肺外结核性,约占全部结核病的1%。TBM的死亡率和致残率高,至今仍是发展中国家最严重的疾病之一。儿童患者及合并HIV感染的结核性脑膜炎患者死亡率明显增高。结核性脑膜炎的具体发病机制仍不清楚,细菌和宿主的遗传因素在结脑的发病机制中发挥了至关重要的作用。尽管现代医学技术的进展,TBM的早期诊断仍存在困难。TBM的诊断依赖于临床表现、实验室检查以及影像学检查,脑脊液细菌涂片或培养找到结核分枝杆菌可确诊。早期诊断和治疗尤为关键。临床上往往从经验判断开始抗结核治疗。WHO指南推荐至少六个月的抗结核治疗。然而,部分指南推荐延长抗结核治疗至9-12个月。早期使用类固醇类激素可降低死亡率。抗结核药物耐药性与高死亡率相关。该综述描述了结脑的各个方面,重点强调结核性脑膜炎的早期诊断和治疗。

Tuberculous meningitis is a severe form of extrapulmonary tuberculosis, and accounts for approximately 1% of all TB cases. The mortality and morbidity of tuberculous meningitis are exceptionally high, and so far is still the most serious disease in developing countries. The mortality of children and human immunodeficiency virus-infected patients is higher. The exact pathogenesis of tuberculous meningitis remains unkown, bacterial and host genetic factors in the pathogenesis of tuberculous meningitis played a crucial role. Diagnosis often remains problematic despite many significant advances in diagnostic techniques.TBM diagnosis relies on clinical manifestations, laboratory tests and imaging studies, definitive diagnosis of tuberculous meningitis depends upon the detection of the tubercle bacilli in the CSF, either by smear examination or by bacterial.Antimicrobial therapy often needs to be instituted empirically,much before a bacteriologicaldiagnosis is established. World Health Organization recommends at least 6 months antituberculous therapy for tuberculous meningitis, however, others recommends a 9-12 months antituberculous therapy. Corticosteroids can significantly reduces the death and disabling residual neurological deficit amongst survivors of tuberculous meningitis, if it can be used in the early stage of the disease. Drug resistance is associated with high moriality. This review describes various aspects of tuberculous meningitis, and emphasis on early diagnosis and treatment of tuberculous meningitis.