结核性脑膜炎和病毒性脑膜炎的鉴别诊断评分模型

Differential diagnostic rule for tuberculosis meningitis and viral meningitis

目的通过临床表现及辅助检查,建立结核性脑膜炎和病毒性脑膜炎的鉴别诊断评分模型。方法选取连续住院的结核性脑膜炎和病毒性脑膜炎患者各41例,统计、分析33项临床特征及辅助检查数据。采用logistic回归方法建立评分模型并利用ROC曲线找到诊断切点。结果进入鉴别诊断模型的指标为:CSF糖/血糖<0.5、颅外结核、脑积水、CSF细胞数>37.5×106/L、发病天数>13 d、结核菌特异性抗原阳性。评分≮8分的结核脑可能性大。结论该鉴别诊断评分模型具有较高的诊断敏感度和特异性,可以应用于2种脑膜炎的鉴别诊断。

Objective To establish a simple differential diagnostic rule for tuberculosis meningitis （TBM） and viral meningitis on the basis of clinical and auxiliary examinations. Methods The data were collected from patients admitted to the hospital who were satisfied the diagnostic criteria, including 41 cases of tuberculosis meningitis and 41 cases of viral meningitis. The multivariate logistic regression analysis was used to compare clinical, laboratory and imaging features and find the independent risk factors for TBM to create the differential diagnostic rule. Finally, the ROC curve was used to find the diagnostic cut-off point with the best sensitivity and specificity. Results Six in-dependent predictable factors for TBM were found： CSF glucose/Blood glucose less than 0.5; CSF cell counts〉37.5×10^6/L; Onset 〉13 days; positive tuberculosis antigen; extrapulmonary tuberculosis; hydrocephalus. It was more likely to be tuberculous meningitis when the score was not less than 8 points. Conclusion The differential diagnostic rule for tuberculosis meningitis and viral meningitis has the satisfying sensitivity and specificity, which could be applied in early clinical differential diagnosis of them.