儿童结核性脑膜炎预后及相关危险因素分析

Analysis of prognosis and related risk factors in children with tuberculous meningitis

目的分析儿童结核性脑膜炎(TBM)预后及相关危险因素。方法选取郑州市第六人民医院2010-01─2016-10收治的150例儿童TBM的临床资料,并对其预后进行随访。根据患者预后情况分为病死组(n=32)与对照组(n=118),分析其相关危险因素。结果与病死组相比,存活组<2岁者卡介苗接种率较高,差异有统计学意义(P<0.05);与病死组相比,存活组惊厥、意识障碍发生率较低,住院时间较长,且临床分期主要以中期为主,差异均有统计学意义(P<0.05);与病死组相比,存活组结核菌素试验(PPD)阳性率较高,脑积水及脑脊液微量蛋白>3 g/L发生率均较低,差异均有统计学意义(P<0.05);与病死组相比,存活组抗结核治疗、鞘内注射及糖皮质激素治疗率均较高,差异有统计学意义(P<0.05);临床分期晚期及住院时间较短均是影响儿童TBM预后相关危险因素(P<0.05)。结论<2岁接种卡介苗、是否存在意识障碍、惊厥、PPD阳性、脑积水、脑脊液微量蛋白是否>3 g/L、临床分期晚、抗结核治疗是否正规、住院时间短、鞘内注射及糖皮质激素是否应用均与TBM患儿预后联系密切,其中住院时间与临床分期为儿童TBM主要危险因素。

Objective To analyze the prognosis and related risk factors in children with tuberculous meningitis(TBM).Methods The clinical data of 150 children with TBM in our hospital from January 2010 to October 2016 were selected,and their prognosis was followed up.According to the prognosis,they were divided into the death group(n=32)and the control group(n=118).And the related risk factors were analyzed.Results Compared with the death group,the inoculation rate of Bacillus Calmette Guerin in the survival group(<2 years old)was significantly higher,and the difference was statistically significant(P<0.05).Compared with the death group,the rate of convulsion and consciousness disorder in the survival group was lower,the time of hospitalization was longer,and the clinical stage was mainly in the middle period,and the difference was statistically significant(P<0.05).Compared with the death group,the positive rate of tuberculin test(PPD)in the survival group was higher,the incidence of hydrocephalus and microprotein>3 g/L in cerebrospinal fluid were all lower,and the difference was statistically significant(P<0.05).Compared with the death group,the effective rates of the treatment with anti tuberculosis,the intrathecal injection and the glucocorticoid in the survival group were all higher,and the difference was statistically significant(P<0.05).The late clinical stage and shorter hospitalization were all risk factors affecting TBM prognosis in children(P<0.05).Conclusion Vaccination with Bacillus Calmette Guerin at the age<2 years old,whether there the existence of disturbance of consciousness,convulsion and PPD positive,whether the hydrocephalus and microprotein in cerebrospinal fluid>3 g/L,the late clinical stage,normal tuberculosis treatment,short hospitalization time,whether application of intrathecal injection and glucocorticoid are closely related to the prognosis of children with TBM,in which,the hospitalization time and clinical stage are the main risk factors of TBM in children.