结核性脑膜炎合并血行播散性肺结核患者35例临床分析  

Clinical analysis of 35 cases of tuberculous meningitis complicated with disseminated pulmonary tuberculosis

作　　者：李薇[1] 白洪忠[2] 李军霞[1] 李敬[1] 孟艺哲 陈颜强[1] LI Wei;BAI Hong-zhong;LI Jun-xia;LI Jing;MENG Yi-zhe;CHEN Yan-qiang(Department of Neurology,Hebei Chest Hospital,Hebei Shijiazhuang 050041,China;Hebei Chest Hospital,Hebei Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院神经内科,河北石家庄050041 [2]河北省胸科医院,河北石家庄050041

出　　处：《中国医刊》2019年第2期148-151,共4页Chinese Journal of Medicine

基　　金：河北省医学科学研究重点课题(20150139)

摘　　要：目的分析结核性脑膜炎合并血行播散性肺结核的临床及辅助检查特点。方法回顾性分析河北省胸科医院2010年10月至2014年10月收治的35例结核性脑膜炎合并血行播散性肺结核患者的临床表现及辅助检查特点。结果 35例患者临床表现多以发热、头痛等为主,所有患者脑脊液细胞数均有升高,21例患者脑脊液蛋白升高,14例脑脊液葡萄糖降低,23例脑脊液氯化物降低,17例颅压升高。所有患者胸部CT均可见粟粒状结节影。共26例行头颅MRI检查,其中异常者24例,表现为脑膜强化、脑积水、颅内结核瘤及混合型。结论血行播散性肺结核与结核性脑膜炎密切相关,充分评估患者一般情况、临床表现及辅助检查,尤其是行腰穿及头颅MRI增强扫描有助于明确诊断。Objective To analyze the clinical and auxiliary examination characteristics of tuberculous meningitis complicated with military tuberculosis.Method The clinical and auxiliary examination characteristics of 35 cases of tuberculous meningitis complicated with disseminated pulmonary tuberculosis were analyzed retrospectively.Result 35 cases of patients with clinical manifestations of fever,headache.Cerebrospinal fluid(CSF) cell count increased in all patients,CSF protein increased in 21 cases,CSF glucose decreased in 14 cases,CSF chloride decreased in 23 cases,and 17 patients had elevated intracranial pressure.Chest CT showed miliary nodules in all patients,a total of 26 patients underwent MRI examination,24 cases showed abnormal meningeal enhancement,hydrocephalus,intracranial tuberculoma and mixed type.Conclusion Hematogenous disseminated pulmonary tuberculosis and tuberculous meningitis are closely related.Fully assessment of the general condition of patients,clinical manifestation and auxiliary examination,especially strengthen the lumbar puncture and brain MRI are helpful for the diagnosis.

关 键 词：结核性脑膜炎 血行播散性肺结核 诊断 脑脊液 

分 类 号：R529.3[医药卫生—内科学]