青年结核性脑膜炎患者并发脑梗死危险因素分析

Analysis on the risk factors of cerebral infarction in young patients with tuberculous meningitis

目的探讨无常规血管危险因素的青年结核性脑膜炎(TBM)患者并发脑梗死的危险因素。方法回顾性分析2015年8月至2019年11月沈阳市第十人民医院收治的108例初次诊断为TBM患者临床资料,依据磁共振成像检查是否并发脑梗死将患者分为并发脑梗死组(25例)和无脑梗死组(83例)。比较2组一般资料及脑脊液检查、影像学表现,采用单因素及二元Logistic回归分析TBM并发脑梗死的危险因素。结果并发脑梗死组患者TBM病程长于无脑梗死组,TBM分期2~3期、脑神经麻痹及脑膜强化比例高于无脑梗死组[76.0%(19/25)比38.6%(32/83)、32.0%(8/25)比8.4%(7/83)、40.0%(10/25)比19.3%(16/83)](均P<0.05)。Logistic回归分析结果显示,TBM分期是TBM并发脑梗死的独立危险因素(比值比=3.397,95%置信区间:1.132~10.192,P=0.029)。结论TBM病程、TBM分期、脑神经麻痹及脑膜强化是无常规血管危险因素的青年TBM患者并发脑梗死的危险因素,而TBM分期是其独立危险因素。

Objective To investigate the risk factors of cerebral infarction in young patients of tuberculous meningitis(TBM)without conventional vascular risk factors.Methods Clinical data of 108 patients diagnosed as TBM in first time admitted to Shenyang 10 th People’s Hospital from August 2015 to November 2019 were retrospectively analyzed.According to whether patients were complicated with cerebral infarction confirmed by magnetic resonance imaging,they were divided into cerebral infarction group(25 cases)and non cerebral infarction group(83 cases).The general information,cerebrospinal fluid examination and imaging manifestations of the two groups were compared.The risk factors of TBM complicated with cerebral infarction were analyzed by univariate and binary Logistic regression.Results The course of TBM in the cerebral infarction group was longer than that in the non cerebral infarction group,the proportions of TBM stage 2-3,cranial nerve palsy and meningeal enhancement in the cerebral infarction group were higher than those in the non cerebral infarction group[76.0%(19/25)vs 38.6%(32/83),32.0%(8/25)vs 8.4%(7/83),40.0%(10/25)vs 19.3%(16/83)](all P<0.05).Logistic regression analysis showed that TBM stage was an independent risk factor for TBM complicated with cerebral infarction(odds ratio=3.397,95%confidence interval:1.132-10.192,P=0.029).Conclusion The course of TBM,TBM stage,cranial nerve palsy and meningeal enhancement are risk factors for cerebral infarction in young TBM patients without conventional risk factors for vascular disease,and TBM stage is an independent risk factor.