鞘内注射不同剂量异烟肼联合地塞米松治疗结核性脑膜炎的效果

The Efficacy of Intrathecal Injection of Different Doses of Isoniazid Combined with Dexamethasone in the Treatment of Tuberculous Meningitis

目的比较鞘内注射不同剂量异烟肼联合地塞米松治疗结核性脑膜炎(TBM)的效果。方法选择驻马店市中心医院2019年1月至2022年12月60例TBM患者,以随机数字表法分为小剂量组和大剂量组,各30例。两组患者均给予常规抗结核治疗,小剂量组给予鞘内注射100 mg异烟肼联合5 mg地塞米松,大剂量组给予鞘内注射200 mg异烟肼联合5 mg地塞米松,均持续治疗3个月。比较两组临床疗效、脑脊液指标(细胞计数、蛋白质、氯化物、葡萄糖)及炎症水平[白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)],并统计两组治疗期间不良反应发生情况。结果大剂量组临床总有效率高于小剂量组(P<0.05);治疗3个月时,大剂量组脑脊液细胞计数、蛋白质水平低于小剂量组,氯化物、葡萄糖水平高于小剂量组(P<0.05);治疗3个月时,大剂量组血清IL-8、TNF-α水平均低于小剂量组(P<0.05);两组治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论TBM患者采用鞘内注射大剂量异烟肼联合地塞米松治疗可提高效果,改善脑脊液指标及炎症水平,且不会增加不良反应。

Objective To compare the efficacy of intrathecal injection of different doses of isoniazid combined with dexamethasone in the treatment of tuberculous meningitis(TBM).Methods Sixty TBM patients from Zhumadian Central Hospital from January 2019 to December 2022 were selected and randomly divided into a low-dose group and a high-dose group using a random number table method,with 30 patients in each group.Both groups of patients were given routine anti-tuberculosis treatment.The low-dose group received intrathecal injection of 100 mg isoniazid combined with 5 mg dexamethasone,while the high-dose group received intrathecal injection of 200 mg isoniazid combined with 5 mg dexamethasone,both of which continued for 3 months.The clinical efficacy,cerebrospinal fluid indexes(cell count,protein,chloride,glucose)and inflammation levels[interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]were compared between the two groups,and the incidence of adverse reactions during treatment was counted.Results The total clinical efficacy rate of the high-dose group was higher than that of the low-dose group(P<0.05).At 3 months of treatment,the cerebrospinal fluid cell count and protein levels in the high-dose group were lower than those in the low-dose group,while chloride and glucose levels were higher than those in the low-dose group(P<0.05).After 3 months of treatment,the levels of serum IL-8 and TNF-αin the high-dose group were lower than those in the low-dose group(P<0.05).The incidence of adverse effects during the treatment period showed no significant difference(P>0.05).Conclusion The treatment of TBM patients with intrathecal injection of high-dose isoniazid combined with dexamethasone can improve efficacy,improve cerebrospinal fluid indicators and inflammation levels,and do not increase adverse reactions.