小儿结核性脑膜炎68例临床分析

Clinical analysis of 68 cases of pediatric tubercular meningitis

目的探讨小儿结核性脑膜炎的临床特点及早期诊断方法。方法回顾性分析2009年10月至2012年10月在我院确诊或临床诊断为结核性脑膜炎的68例住院患儿的临床资料。结果 68例病例中,男36例,女32例,年龄(4±4.35)岁。5例确诊病例,脑脊液结核杆菌培养阳性;63例为临床诊断病例。临床主要表现为:发热64例(94%);头痛和/或呕吐38例(56%);抽搐26例(38%);意识障碍33例(48%);脑膜刺激征阳性38例(56%);偏瘫27例(40%);25例伴颅神经损害,以动眼神经和外展神经受损为主。合并脑外结核47例(69%)。未接种卡介苗18例(27%),有明确肺结核接触史28例(42%)。脑脊液异常62例(92%),呈非化脓性改变,白细胞增高以淋巴细胞为主,蛋白质升高,糖、氯化物降低。头颅影像学有异常发现62例(92%),脑室扩张、交通性(梗阻性)脑积水和脑梗死最常见。全部病例均接受抗结核治疗,12例行侧脑室外引流术,其中11例转神经外科行脑室-腹腔分流术。好转或治愈62例(92%),后遗症28例(42%),自动出院2例(4%),死亡2例(4%)。结论该病临床表现复杂多样,早期症状和体征均缺乏特异性,仔细询问病史和结核接触史,结合脑脊液、头颅影像学、结核菌素试验是早期诊断的关键。

were note extra-CNS TB. 27% children had not received BCG, and 42% cases had exposure to tuberculosis patients. CSF of 62 cases showed abnormalities, which were non-purulent, high classification of lymphocytes, high protein concentrations and low concentrations of glucose as well as chloride. Obvious abnormalities in brain CT or MRI were presented in 62 cases （92%）, such as ventriculomegaly, communicating/obstructive hydrocephalus and cerebral in-farction. All isolates had accepted anti-TB treatment. 12 children underwent external ventricular drain, and 11 cases underwent ventriculoperitoneal shunt surgery. 62 cases had good outcome, but 28 children had neurological sequelae. 2 cases of death reported （ 4%） . Conclusion The clinic features of pediatric tubercular meningitis is incomplete and the clinical findings are usually non-distinctive. The diagnosis of pediatric tubercular meningitis depends upon contact history, test of CSF, brain CT/MRI and tuberculin skin test.