结核性脑膜炎38例临床分析

Clinical analysis of tuberculous meningitis: on 38 cases reports

目的分析结核性脑膜炎临床症状、早期诊断和治疗方法。方法回顾性分析2017年1-12月医院收治的结核性脑膜炎患者38例的临床资料。结果 38例结核性脑膜炎中症状不典型16例(42.1%),脑脊液改变不典型11例(28.9%),所有患者均合并肺结核,合并肺外结核感染30例(78.9%)。治疗后38例患者出现肝功能损害3例,均为轻度肝功能损害,可耐受结核药物治疗;好转出院34例,自动出院3例,死亡1例;行脑脊液分流术1例。结论分析结核性脑膜炎患者的临床症状、脑脊液常规及生化检查、脑脊液RNA检查、头颅MRI改变,有助于提高结核性脑膜炎诊断率,脑脊液RNA检查有利于结核性脑膜炎早期诊断,对合并血行播散型肺结核、全身多处结核感染患者常规进行结核性脑膜炎筛查,可减少漏诊率,有利于早期发现不典型结核性脑膜炎患者。

Objective To analyze the clinical symptoms,early diagnosis and treatment of tuberculous meningitis.Methods The clinical data of 38 patients with tuberculous meningitis admitted to hospital from January to December in 2017 were retrospectively analyzed.Results Among 38 cases of tuberculous meningitis,there were 16 cases（42.1%） with atypical symptoms and 11 cases（28.9%） with atypical cerebrospinal fluid changes.All patients were complicated with tuberculosis and30 cases（78.9%） with extrapulmonary tuberculosis infection.After treatment,38 patients had liver function damage in 3 cases,all of which were mild liver function damage and could be tolerated by tuberculosis drug treatment; 34 cases were discharged from hospital,3 cases were discharged automatically,1 case died,and 1 case was cerebrospinal fluid shunt.Conclusion Analysis of clinical symptoms,cerebrospinal fluid routine and biochemical examination,cerebrospinal fluid RNA examination,and head MRI changes in patients with tuberculous meningitis can help to improve the diagnosis rate of tuberculous meningitis.Cerebrospinal fluid RNA examination is beneficial for the early diagnosis of tuberculous meningitis.Routine screening for tuberculous meningitis combined with hematogenous disseminated tuberculosis,multiple patients with tuberculosis infection can reduce the rate of missed diagnosis,is conducive to early detection of patients with atypical tuberculous meningitis.