回顾性分析结核性脑膜炎55例患儿的临床资料

Retrospective Study of Tuberculosis Meningitis Clinical and Laboratory Testing and Diagnosis

目的评价小儿结核性脑膜炎（TBM）的临床、实验室和影像学特征,为诊断和判定TBM预后提供科学依据。方法收集55例诊断为TBM患儿的年龄、性别、结核病史、入院前症状持续时间（〉5 d）、临床症状、临床分期、实验室检测数据、胸部X线片、头颅CT或MRI改变及预后等临床资料进行回顾性分析。结果 55例患儿年龄1.5~12.0岁,平均年龄（5.32±2.98）岁,〈6岁38例（69.09%）。临床特点：有结核病史33例（60.00%）;TBM临床表现分期为Ⅱ或Ⅲ期46例（83.64%）,入院前症状持续时间（DSBA）〉5 d 47例（85.45%）。除死亡8例（14.54%）外,余均给予至少6个月的抗结核治疗。评价疗效：正常8例（14.54%）、轻微后遗症23例（41.82%）和严重后遗症16例（29.09%）。单因素分析：结核病史、精神症状、抽搐、年龄、局部神经功能障碍、临床表现分期为Ⅱ和Ⅲ期、头颅CT和MRI改变是预后不良的相关影响因素。多因素Logistic回归分析表明：临床表现分期为Ⅲ期,头颅CT和MRI有改变的患儿预后较差。结论 TBM患儿临床症状特异性差,确诊时已合并脑损伤,尤其是临床分期晚、颅内有病变的患儿预后较差,早期诊断和治疗可显著改善预后。

Aim To assess the relationship between presenting clinical characteristics and outcome of pediatric tuberculous meningitis.Methods A retrospective study of all the children diagnosed with tuberculous meningitis in our hospital between Jan.2004 and Feb.2012 was presented,and the demographic,clinical,and diagnostic characteristics with clinical outcome after 6 months of the treatment were compared.Results 55 patients were included,common characteristics on admission were young age 38 cases（69.09%;6 years）,stage Ⅱ or Ⅲ tuberculous meningitis 46 cases（83.64%）,duration of symptoms before admission（DSBA） days5 days 47 cases（85.45%）,etc.Factors associated with poor outcome in univariate analysis were as follows：history of TB,psychiatric symptoms,seizures,focal neurological deficit,stage Ⅱ,stage Ⅲ tuberculous meningitis,abnormal cerebral CT or MRI,encephaledema,cerebral infarction,stage Ⅲtuberculous meningitis and abnormal cerebral CT or MRI with poor outcome in multivariate Logistic regression analysis.Conclusion Tuberculous meningitis starts with nonspecific symptoms and was often onlydiagnosed when brain damage had already occurred.Earlier diagnosis will improve outcome significantly.Presenting variables independently associated with poor clinical outcome were able to be identified.