结核性脑膜炎129例的临床与病理  

Clinical and pathological manifestions in 129 patients with tuberculous meningitis

作　　者：冯玉麟[1] 刘立荣[1] 张尚福[1] 王曾礼[1] 王安琼 

机构地区：[1]成都华西医科大学第一附属医院内科

出　　处：《中华结核和呼吸杂志》1997年第3期161-163,共3页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨结核性脑膜炎（结脑）的诊断。方法对１９５２～１９９４年经尸检证实的１２９例结脑进行回顾性分析。结果生前误诊６４例，误诊率为４９．６％，其中３４例误诊为其他脑部疾病，余３０例误诊为重症肺结核、重症肺炎、胃癌、风湿性心脏病、肺心病及白血病。临床上以脑膜炎和脑外结核表现为主，脑脊液改变为压力升高，细胞计数与蛋白含量增高，糖与氯化物降低。脑ＣＴ显示脑实质粟粒性结节影，颅底面、脑脚间池和大脑裂呈高密度星状阴影，脑水肿、脑室扩大与脑梗塞。尸检发现脑膜、脑实质、脑室、脑血管均有结核病变。结论临床表现，脑脊液检查，结合头部ＣＴ和脑外结核灶是诊断结脑的基本依据。Objective To investigate the diagnosis of tuberculous meningitis.Method One hundred twenty-nine cases of tuberculous meningitis proved by autopsy,from the year 1952 through 1994,were retrospectively reviewed. Results Sixty four cases were misdiagnosed before death,and the misdiagnosis rate was 49.6%.Among these misdiagnosed cases,34 were misdiagnosed as other brain diseases,and the other 30 cases were misdiagnosed as severe pulmonary tuberculosis,severe pneumonia,gastric cancer,rheumatic heart disease,cor pulmonale and leukemia,etc.The main clinical manifestations included meningitis and extra cerebral tuberculous syndromes.The cerebral spinal fluid changes included pressure increase,elevation of cell counts and protein content,decrease of glucose and chlorides.Both cerebral CT and intensified scan showed miliary tubercles in the brain parenchyma.High density stellate type of shadows in the basal surface of the brain,interpedunclar forsa and cerebral fissures,enlargement of brain ventricles,cerebral edema and thrombosis were also shown.Tuberculous lesions in the meninges,brain parenchyma,brain ventricles and brain blood vessels were found by autopsy.Conclusion The clinical manifestations,cerebral spinal fluid examination,in combination with CT scan of the head,and searching for extracerebral tuberculous foci are the basis for the diagnosis of tuberculous meningitis.

关 键 词：诊断 病理学 结核性脑膜炎 

分 类 号：R529.3[医药卫生—内科学]