结核性胸膜炎患者并发结核性脑膜炎的早期诊断体会

Early diagnosis of tuberculous pleurisy complicated with tuberculous meningitis

目的:评价结核性胸膜炎患者同时患有结核性脑膜炎的早期诊断情况。方法:2017年2月-2020年1月收治结核性胸膜炎患者26例,研究胸腔积液总量及同时患有结核性脑膜炎情况,调查患者影像学特征、胸水常规及生化结果、脑脊液特异性改变。结果:胸腔积液总量处于500~800 mL 7例、800~1 100 mL 12例、1 100 mL以上7例,患结核性脑膜炎情况依次为57.14%、66.67%、85.71%。胸部CT显示结核病灶85.71%。头颅磁共振常规检测阳性变化69.23%,头颅磁共振加强检测呈现脑室扩大20.44%,所有患者头颅增强核磁均显示不同程度脑膜强化,部分显示脑间质渗出性改变。脑脊液压力值200 mmH2O以下30.77%,脑脊液压力值200~350 mmH2O 57.69%,脑脊液压力值350mmH2O以上11.54%。脑脊液白细胞数目上升69.23%,单核细胞数目增加57.69%,多核细胞数目增加57.69%。脑脊液蛋白定量检测结果上升92.31%。结论:结核性胸膜炎患者同时患有结核性脑膜炎对于早期诊断具有重要意义。

Objective:To evaluate the early diagnosis of tuberculous pleurisy with tuberculous meningitis.Methods:From February 2017 to January 2020,26 patients with tuberculous pleurisy were selected,we studied the total amount of pleural effusion and the situation of tuberculous meningitis,and to investigate the imaging characteristics,the routine and biochemical results of pleural fluid,and the specific changes of cerebrospinal fluid.Results:The total amount of pleural effusion was 500~800 mL in 7 cases,800~1100 mL in 12 cases,and more than 1100 mL in 7 cases.The incidence of tuberculous meningitis was 57.14%,66.67%and 85.71%,respectively.Chest CT showed 85.71%tuberculosis.The positive rate of routine head magnetic resonance examination was 69.23%.Enhanced brain magnetic resonance examination showed that the ventricle was enlarged by 20.44%.All patients showed meningeal enhancement in varying degrees,and some showed interstitial exudative changes.Cerebrospinal fluid pressure values less than 200 mmH2O accounted for 30.77%,cerebrospinal fluid pressure values 200~350 mmH2O accounted for 57.69%,cerebrospinal fluid pressure values over 350 mmH2O accounted for 11.54%.The number of leukocytes in cerebrospinal fluid increased by 69.23%,the number of monocytes increased by 57.69%,and the number of multinucleated cells increased by 57.69%.The result of quantitative detection of cerebrospinal fluid protein increased by 92.31%.Conclusion:It is of great significance for early diagnosis that patients with tuberculous pleurisy also suffer from tuberculous meningitis.