华西医学

华西医学

119 例结核性脑膜炎患者长期预后危险因素的单中心回顾性研究

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目的 探讨对结核性脑膜炎患者长期不良预后具有预测价值的临床指标。 方法 回顾性分析四川大学华西医院 2011 年 8 月 1 日 0 时 0 分 0 秒—2012 年 7 月 31 日 23 时 59 分 59 秒期间住院收治的结核性脑膜炎病例的入院时临床资料(一般临床资料、实验室检查结果、影像学检查结果),电话随访患者患病 6 年后的预后结果,通过改良 Rankin 量表评分(modified Rankin Scale,mRS)(0~6 分)量化结局指标并根据 mRS 分值将预后分为良好组(0 分≤mRS<3 分)与不良组(3 分≤mRS≤6 分),用 logistic 回归分析影响患者长期不良预后的独立危险因素。 结果 共纳入 119 例患者,其中男 63 例,女 56 例,平均年龄(35±17)岁;预后不良 53 例,预后良好 66 例。单因素分析得出年龄(t=–3.812,P<0.001)、入院时收缩压(t=–2.009,P=0.049)、格拉斯哥昏迷评分(t=3.987,P<0.001)、英国医学研究理事会(Medical Research Council,MRC)结核性脑膜炎疾病分期(Z=–4.854,P<0.001)、头痛(χ2=4.101,P=0.043)、意识改变(χ2=10.621,P=0.001)、认知功能障碍(χ2=4.075,P=0.044)、颅神经麻痹(χ2=5.853,P=0.016)、外周神经功能异常(χ2=14.925,P<0.001)、脑膜刺激征(χ2=7.174,P=0.007)、血钾(t=3.080,P=0.003)、脑脊液蛋白含量(Z=–2.568,P=0.010)、脑脊液氯(t=2.543,P=0.012)、脑积水(χ2=11.766,P=0.001)、脑梗死(χ2=6.539,P=0.012)与结核性脑膜炎长期不良预后相关。多因素分析显示患者年龄[比值比(odds ratio,OR)=1.061,95% 置信区间(confidence interval,CI)(1.027,1.096),P<0.001]、外周神经功能异常[OR=3.537,95%CI(1.070,11.697),P=0.038]、MRC Ⅱ 期[OR=9.317,95%CI(1.692,51.303),P=0.010]、MRC Ⅲ 期[OR=43.953,95%CI(3.996,483.398),P=0.002]与结核性脑膜炎长期不良预后独立相关;脑积水[OR=2.826,95%CI(0.999,8.200),P=0.050]可能与结核性脑膜炎长期不良预后独立相关。 结论 年龄、MRC 分期(Ⅱ、Ⅲ 期)、外周神经功能异常是结核性脑膜炎长期不良预后的独立危险因素。脑积水可能是结核性脑膜炎长期不良预后的独立危险因素。

Objective To explore the predictive factors for long-term adverse prognosis in patients with tuberculosis meningitis. Methods We retrospectively analyzed the clinical data (general clinical data, laboratory test results, and imaging findings) of hospitalized cases of tuberculosis meningitis admitted to West China Hospital of Sichuan University from 00:00:00 on August 1st, 2011 to 23:59:59 on July 31st, 2012. We collected data of prognosis results after 6 years of illness by telephone follow-up, and quantified outcome measures by modified Rankin Scale (mRS) score (0–6 points). According to the mRS score, the cases obtaining 0 points≤mRS<3 points were divided into the good prognosis group and the cases obtaining 3≤mRS≤6 points were divided into the poor prognosis group, logistic regression analysis was executed to find the independent risk factors affecting long-term poor prognosis. Results A total of 119 cases were included, including 63 males and 56 females; the average age was (35±17) years. Among them, 53 patients had poor prognosis and 66 patients had good prognosis. After univariate analysis, the age (t=–3.812, P<0.001), systolic blood pressure at admission (t=–2.009, P=0.049), Glasgow Coma Scale score (t=3.987, P<0.001), Medical Research Council (MRC) staging system (Z=–4.854, P<0.001), headache (χ2=4.101, P=0.043), alter consciousness (χ2=10.621, P=0.001), cognitive dysfunction (χ2=4.075, P=0.044), cranial nerve palsy (χ2=5.853, P=0.016), peripheral nerve dysfunction (χ2=14.925, P<0.001), meningeal irritation (χ2=7.174, P=0.007), serum potassium (t=3.080, P=0.003), cerebrospinal fluid protein content (Z=–2.568, P=0.010), cerebrospinal fluid chlorine (t=2.543, P=0.012), hydrocephalus (χ2=11.766, P=0.001), and cerebral infarction (χ2=6.539, P=0.012) were associated with long-term poor prognosis of tuberculosis meningitis. Multivariate analysis showed that age [odds ratio (OR)=1.061, 95% confidence interval (CI) (1.027, 1.096), P<0.001], peripheral nerve dysfunction [OR=3.537, 95%CI (1.070, 11.697), P=0.038], MRC Stage Ⅱ[OR=9.317, 95%CI (1.692, 51.303), P=0.010], MRC Stage Ⅲ [OR=43.953, 95%CI (3.996, 483.398), P=0.002] were the independent risk factors for long-term poor prognosis of tuberculosis meningitis. Hydrocephalus [OR=2.826, 95%CI (0.999, 8.200), P=0.050] might be an independent risk factor for long-term poor prognosis of tuberculosis meningitis. Conclusions Age, MRC staging system (Stage Ⅱ, Stage Ⅲ) and peripheral neurological dysfunction are chronic poor-prognostic independent risk factors for tuberculosis meningitis. Hydrocephalus may be associated with long-term adverse prognosis of tuberculosis meningitis

关键词: 结核性脑膜炎; 预后; 预测因子

Key words: Tuberculosis meningitis; Prognosis; Predictor

引用本文: 谷志寒, 程涛, 朱艾晶, 曹钰. 119 例结核性脑膜炎患者长期预后危险因素的单中心回顾性研究. 华西医学, 2019, 34(1): 35-42. doi: 10.7507/1002-0179.201812089 复制

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