利奈唑胺联合抗结核药物治疗重症结核性脑膜炎临床观察

The clinical observation of linezolid and anti-tuberculosis drugs in patients with severe tuberculous meningitis

目的探讨利奈唑胺联合常规抗结核药物对重症结核性脑膜炎的临床疗效。方法将84例重症结核性脑膜炎患者随机分为观察组(43例)和对照组(41例),2组均给常规抗结核药物治疗,观察组在此基础上给予利奈唑胺治疗,均治疗4周。比较治疗前后格拉斯哥昏迷指数(GCS)评分、脑脊液白细胞数、葡萄糖、蛋白质、氯化物以及C反应蛋白(CRP)、神经元特异性烯醇化酶(NSE)、神经生长因子(NGF)等指标水平。结果观察组治疗后GCS评分以及脑脊液各项指标水平均有明显改善,并且观察组GCS评分(11.80±1.90)分以及脑脊液葡萄糖[(2.61±0.70)mmol/L]、氯化物[(136.72±25.82)mmol/L]水平高于对照组,脑脊液白细胞数[(10.75±2.60)×10^6/L]、蛋白质[(0.62±0.18)g/L]、[CRP(2.77±0.74)mg/L]、NSE[(10.50±2.25)mg/L]和[NGF(14.25±3.07)ngl/L]低于对照组,差异均有统计学意义(P<0.05)。结论利奈唑胺联合常规抗结核药物治疗可改善重症结核性脑膜炎患者脑脊液各项指标水平,有效促进临床症状和体征的恢复。

Objective To explore the clinical efficacy of linezolid and conventional anti-tuberculosis drugs in patients with severe tuberculous meningitis.Methods 84 patients with severe tuberculous meningitis were randomly divided into observation group(43 cases)and control group(41 cases).The two groups were given conventional quadruple anti-tuberculosis drugs,and the observation group was given linezolid on the basis of the above treatment.Both groups were treated for 4 weeks.The glasgow coma index(GCS)score and cerebrospinal fluid indicators of leukocyte count,glucose,protein,chloride,C-reactive protein(CRP),neuron-specific enolase(NSE)and nerve growth factor(NGF)were compared between the two groups before and after treatment.Results The GCS scores and cerebrospinal fluid indicators levels in the observation group were significantly improved after treatment(P<0.05).The GCS scores(11.80±1.90 scores)and the cerebrospinal fluid levels of glucose(2.61±0.70 mmol/L)and chloride(136.72±25.82 mmol/L)in the observation group were significantly higher than the control group(P<0.05),and the cerebrospinal fluid levels of white blood cells(10.75±2.60×10^6/L),protein(0.62±0.18 g/L),CRP(2.77±0.74 mg/L),NSE(10.50±2.25 mg/L)and NGF(14.25±3.07 ngl/L)in the observation group were significantly lower than the control group(P<0.05).Conclusion The combination drugs of linezolid and conventional anti-tuberculosis could improve the indicators levels of cerebrospinal fluid in patients with severe tuberculous meningitis,effectively promote the recovery of clinical symptoms and signs.