结核性脑膜炎患儿生化及脑脊液检测结果与预后的相关性研究

Correlation between biochemical and cerebrospinal fluid test results and prognosis in children with tuberculous meningitis

目的探讨结核性脑膜炎(TBM)患儿生化指标及脑脊液(CSF)检测结果和病情预后的相关性分析,旨在为临床TBM的预后评估提供有效的检查方案。方法选择2006年6月-2015年6月医院儿科及感染科接诊的TBM患儿182例,按照病情预后的不同分为预后良好组93例和预后不良组89例,观察两组患儿干预前实验室生化指标检测与CSF细胞学检测数值差异,分析TBM预后相关影响因素。结果预后良好组中性粒细胞、淋巴细胞、单核细胞表达均明显低于预后不良组,差异有统计学意义(P<0.05);预后良好组血浆生化指标肌酐(Cre)、总胆红素(TBIL)、尿素氮(BUN)表达水平与预后不良组比较差异无统计学意义,白蛋白(ALB)、总蛋白(TP)、谷草转氨酶(AST)、谷丙转氨酶(ALT)的表达均显著低于预后不良组,差异有统计学意义(P<0.05);logistic回归分析,TBM患儿预后与TP、AST、ALT有密切相关性(P<0.05)。结论血浆生化检验对TBM患儿的预后结果具有一定诊断意义,可初步认定,血浆生化检验可用于TBM疾病的诊断与预后评估,关于其临床实用性需进一步以大样本实验进行验证。

OBJECTIVE To investigate the relationship between biochemical markers of cerebrospinal fluid （CSF） test results and prognosis of patients with tuberculous meningitis （TBM）,so as to provide an effective inspection program for the evaluation of clinical prognosis of TBM.METHODS A total of 182 patients with TBM who were treated in pediatrics department and infection control department in our hospital from Jun.2006 to Jun.2015 were retrospectively chosen.According to the prognosis of the disease,they were divided into two groups,namely the good prognosis group of 93 cases and the poor prognosis of 89 cases.The differences of laboratory biochemical tests and CSF cytology tests of the two groups before intervention of the two groups were observed,and the TBM prognosis-related factors were analyzed.RESULTS The expression of neutrophil,lymphocyte and rnonocyte in good prognosis group were significantly lower than those in poor prognosis group （P〈0.05）.The expression levels of Cre,TBIL and BUN in good prognosis group had no significant difference with those in poor prognosis group.The expression levels of ALB,TP,AST and ALT in good prognosis group were significantly lower than those in poor prognosis group （P〈0.05）.Logistic regression analysis showed that the prognosis of children were significantly related with TBM and TP,AST and ALT （P〈0.05）.CONCLUSION Plasma biochemical tests for TBM children prognosis have some diagnostic significance.It can be initially identified,plasma biochemical tests can be used for the diagnosis and prognosis of TBM disease assessment,and the clinical utility need to further verify by large-scale experiments.