华西医学

华西医学

免疫及分子技术助力诊断:黔北地区 152 例结核性脑膜炎患者临床特点分析

查看全文

目的 全面仔细地观察、认识、学习和理解结核性脑膜炎(tuberculous meningitis,TBM)的临床特点。 方法 回顾性分析 2016 年 1 月—2017 年 2 月在遵义医学院第一附属医院呼吸二科住院治疗的 152 例 TBM 患者的一般资料、临床表现、临床检验检查及治疗预后等情况。 结果 152 例 TBM 患者平均年龄(43.9±20.4)岁,男女比例为 1.45∶1,平均住院时间(20.0±18.9)d。临床表现以头痛[95.4%(145/152)]、恶心呕吐[42.8%(65/152)]、发热[61.8%(94/152)]为主。主要合并疾病为继发性肺结核[52.0%(79/152)]、血行播散性肺结核[37.5%(57/152)]、结核性胸膜炎[30.9%(47/152)]。γ-干扰素释放试验阳性率为 90.8%(129/142),腰椎穿刺脑压升高,典型脑脊液生化改变为“低糖、低氯、高蛋白”。脑脊液结核菌涂片阳性率极低,脑脊液 GeneXpert MTB/RIF 阳性率达 21.9%(7/32)。患者易合并低蛋白血症,比例达 29.6%(45/152),低钠血症比例达 45.3%(69/152)。经早期诊断规范治疗,92.1%(140/152) 好转出院。 结论 TBM 患者以青壮年为主,临床表现多样,呼吸道症状少,易合并肺结核及其他肺外结核,γ-干扰素释放试验和脑脊液 GeneXpert MTB/RIF 可应用于结核病的辅助诊断。早发现早诊断早治疗,进行合理规范化学治疗,加强对症支持治疗,提高 TBM 的精准诊治,可改善其临床预后。

Objective To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis (TBM). Methods We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017. Results The mean age of the 152 patients with TBM was (43.9±20.4) years old, the ratio of male to female was 1.45:1, and the average length of hospital stay was (20.0±18.9) days. The clinical manifestations were mainly headache [95.4% (145/152)], nausea and vomiting [42.8% (65/152)], and fever [61.8% (94/152)]. The main co-morbidities were secondary pulmonary tuberculosis [52.0% (79/152)], hematogenous disseminated tuberculosis [37.5% (57/152)], and tuberculous pleurisy [30.9% (47/152)]. The positive rate of γ-interferon release test was 90.8% (129/142), and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were " low glucose, low chlorine, and high protein”. The positive rate of tuberculosis smear was extremely low, and the positive rate of GeneXpert MTB/RIF in cerebrospinal fluid was 21.9% (7/32). The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6% (45/152), and the proportion of hyponatremia reached 45.3% (69/152). Treated with early diagnosis and treatment, 92.1% (140/152) improved and discharged. Conclusions TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis. γ-interferon release test and cerebrospinal fluid GeneXpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving the precise diagnosis and treatment of TBM, can improve its clinical prognosis.

关键词: 结核性脑膜炎; 临床诊断; 抗结核治疗

Key words: Tuberculous meningitis; Clinical diagnosis; Antituberculosis treatment

引用本文: 王涛, 周亮, 杨红霞, 唐书福, 李娜娜, 陈雪融, 张建勇. 免疫及分子技术助力诊断:黔北地区 152 例结核性脑膜炎患者临床特点分析. 华西医学, 2018, 33(8): 972-976. doi: 10.7507/1002-0179.201807132 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Huang HJ, Ren ZZ, Dai YN, et al. Old age and hydrocephalus are associated with poor prognosis in patients with tuberculous meningitis: a retrospective study in a Chinese adult population. Medicine (Baltimore), 2017, 96(26): e7370.
2. 唐神结, 高文. 临床结核病学. 北京: 人民卫生出版社, 2011: 402-417.
3. Chin JH, Mateen FJ. Central nervous system tuberculosis: challenges and advances in dianosis and treatment. Curr Infect Dis Rep, 2013, 15(6): 631-635.
4. Lee HG, William T, Menon J, et al. Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study. BMC Infect Dis, 2016, 16: 296.
5. 张东升, 张振华. 血行播散型肺结核合并结核性脑膜炎 44 例临床诊治体会. 中外健康文摘, 2013, 10(22): 145-146.
6. 张春艳, 池菲, 张新, 等. 不同方法诊断结核性脑膜炎的价值比较. 疑难病杂志, 2017, 16(4): 356-359, 363.
7. 吴小慧, 刘为勇, 王峰, 等. 评估GeneXpert MTB/RIF技术在结核性脑膜炎诊断中的价值. 神经损伤与功能重建. (2018-07-17). http://kns.cnki.net/kcms/detail/42.1759.R.20180717.1158.002.html.
8. 张瑞雪, 龙铟, 冯国栋, 等. Xpert MTB/RIF对结核性脑膜炎诊断的临床评价. 中华检验医学杂志, 2016, 39(6): 442-447.
9. World Health Organization. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB/RIF ultra compared to Xpert MTB/RIF: WHO/HTM/TB/2017.4. Geneva: World Health Organization, 2017. http://apps.who.int/iris/handle/10665/254792.
10. Davis A, Meintjes G, Wilkinson RJ. Treatment of tuberculous meningitis and its complictions in adults. Curr Treat Options Neurol, 2018, 28, 20(3): 5.
11. 邱建东, 董正梁, 王鑫, 等. 结核性脑膜炎合并低钠血症 104 例临床分析. 世界最新医学信息文摘, 2018, 18(18): 126-127.
12. 唐思颖, 井欢, 王看然, 等. 结核性脑膜炎伴低钠血症的临床特征分析. 重庆医科大学学报, 2018, 43(6): 793-796.
13. 常占林. 结核性脑膜炎合并低钠血症 20 例分析. 西藏医药, 2017, 38(4): 19-20.
14. 张朋. 结核性脑膜炎的临床特征及预后影响因素分析. 中西医结合心脑血管病杂志, 2015, 13(15): 1778-1780.