成人结核性脑膜炎诊疗进展

Advances in diagnosis and treatment of tuberculous meningitis in adults

结核性脑膜炎是一种较为严重的肺外结核病,其早期诊断困难,病死率和致残率高。由于脑脊液中抗酸染色和结核分枝杆菌培养阳性率低,脑脊液改良抗酸染色技术、免疫诊断技术和分子生物学技术(如Gene Xpert)受到重视。结核性脑膜炎的治疗依然是化学治疗为主,其方案依旧以异烟肼、利福平和吡嗪酰胺为核心,疗程建议12个月,部分病例可延长至18个月。高颅内压的治疗主要以脱水剂为主,可多种脱水剂联合应用,激素在改善生存率和临床症状上的价值明确,但对致残率的改善无明显作用。

Tuberculous meningitis is one of the serious extra-pulmonary tuberculosis. It is difficult to diagnose earlier with a high mortality and disability. Modified Ziehl-Neelsen stain, immunodiagnosis and new techniques of molecular biology such as GeneXpert have been valued due to low positive rate of acid-fast bacilli （AFB） and culture from cerebrospinal fluid. Chemothrapy is still main means of management for tuberculous meningitis. The regimen composes of isoniazid, rifampicin and pyrazinamide as core agents. The duration of management is 12 months in most patients and 18 months in partial cases. The management for elevated intracranial pressure is given to dehydrating agents only or in combination. Corticosteroid can improve morbidity and clinical symptoms definitely5 but not for disability.