结核性脑膜炎临床特点观察与治疗分析

Clinical characteristics of tuberculous meningitis and treatment

目的总结结核性脑膜炎的临床表现、诊断和治疗特点,提高对该病的诊治水平。方法回顾性分析113例结核性脑膜炎患者的临床资料,包括实验室检查结果、诊断及预后情况。结果 101例患者呈亚急性、慢性起病,88例合并颅外结核。临床表现以发热、头痛、恶心、呕吐及脑膜刺激征为主;脑脊液改变以压力、细胞数、蛋白升高,糖及氯化物降低为主。77例患者行头颅MRI检查,异常者65例,表现为脑膜强化、脑积水、脑内结核瘤、脊髓损害、混合型。经正规抗结核治疗,临床治愈60例,好转36例,无效12例,死亡5例。结论患者的临床表现、脑脊液检查、头颅影像学检查及是否合并颅外结核病灶是结核性脑膜炎诊断的重要依据。早期诊断和及时合理治疗可以改善结核性脑膜炎患者的预后。

Objective To review the clinical and laboratory features of tuberculous meningitis （TM） in order to improve the diagnostic and therapy level for TM.Methods The data of 113 TM patients were analyzed retrospectively. Results 101 cases showed the features of subacute and chronic disease. The main clinical manifestations of TM were fever, headache, nausea,vomiting and meningeal irritation.The abnormality of cerebrospinal fluid showed increase in the pressure, white blood cell count, and protein level, but decrease in glucose and chlorine.The MRI features of TM were cerebral infarction and hydrocephalus, distention of the affected subarachnoid spaces and abnormal meningeal enhancement and cistern enhancement after Gadolinium-DTPA administration.60 cases were cured and 36 cases were improved after following conventional antituberculous treatment. Unsuccessful treatment or death accounted for 17 cases. Conclusion The clinical manifestations, cerebrospinal fluid findings, head CT or MRI to find extracranial tuberculosis or not are the key in TM diagnosis.Early diagnosis and treatment are the corner for improving the prognosis of TM.