儿童结核性脑膜炎远期预后的危险因素分析

Risk factors for the long-term prognosis of tuberculous meningitis in children

目的分析儿童结核性脑膜炎(TBM)远期预后的危险因素,评价脑脊液(CSF)乳酸脱氢酶(LDH)对TBM远期预后的预测价值。方法回顾分析2013年1月—2019年10月住院TBM患儿的临床资料。结果纳入88例患儿,男48例、女40例,中位年龄7.5岁(3个月~14岁)。其中27例(30.7%)预后不良,包括12例重度残疾及15例死亡;61例(69.3%)预后良好,包括45例治愈,11例轻度残疾,5例中度残疾。与预后良好组相比,预后不良组年龄较小,临床分期为Ⅲ期、肢体瘫痪、惊厥、脑积水比例较高,LDH水平升高,差异均有统计学意义(P<0.05)。采用ROC曲线分析确定CSF中LDH预测TBM预后不良的AUC为0.81(P<0.001,95%CI:0.71~0.88),LDH水平为103 U/L时,灵敏度为63.0%、特异度91.8%、约登指数0.548。多元logistic回归分析发现,临床分期为Ⅲ期(OR=19.48,95%CI:3.49~108.68),LDH≥103 U/L(OR=16.27,95%CI:1.16~227.95)为TBM远期预后不良的独立危险因素;年龄越大,远期预后越好(OR=0.78,95%CI:0.62~0.97)。结论TBM远期预后不良的独立危险因素为临床Ⅲ期及CSF LDH≥103 U/L。CSF中LDH是TBM远期预后不良的有价值的预测因子。

Objective To analyze the risk factors of the long-term prognosis of tuberculous meningitis(TBM)in children,and to evaluate the predictive value of cerebrospinal fluid(CSF)lactate dehydrogenase(LDH)on the long-term prognosis of TBM.Methods The clinical and follow-up data of TBM children admitted between January 2013 to October 2019 were retrospectively analyzed.Results A total of 88 children were included,including 48 boys and 40 girls,with a median age of 7.5 years(3 months to 14 years).Twenty-seven of the 88 patients(30.7%)had poor prognosis,including 12 cases complicated with severe disability and 15 deaths.In contrast,61 cases(69.3%)had a good prognosis,including 45 cases cured,11 children with mild disability and 5 children with moderate disability.Univariate analysis showed that the long-term prognosis was associated with younger age,clinical status at the stage III,limb paralysis,convulsion,significantly increased LDH level and hydrocephalus(all P<0.05).The area under the curve was 0.81(P<0.001,95%CI:0.71-0.88)to predict poor prognosis.When CSF LDH cut-off value≥103 U/L,ROC curve analysis showed that the sensitivity and specificity of the long-term adverse prognosis were 63.0%and 91.8%.Multivariate logistic regression analysis showed that clinical status at the stage III(OR=19.48,95%CI:3.49-108.68)and LDH≥103 U/L(OR=16.27,95%CI:1.16-227.95)were independent risk factors for poor long-term prognosis of TBM(all P<0.05).Conclusions The independent risk factors for long-term poor prognosis of TBM were clinical status at the stage III and CSF LDH≥103 U/L.CSF LDH is a valuable predictor of long-term poor prognosis in TBM.