急性粟粒型肺结核合并结核性脑膜脑炎的临床特征(附2例报道)  

Clinical characteristics of acute miliary pulmonary tuberculosis complicating with tuberculous meningoencephalitis

作　　者：吴茜[1] 陈博[1] 柯高潭 卜碧涛[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《卒中与神经疾病》2015年第2期84-86,共3页Stroke and Nervous Diseases

摘　　要：目的讨论急性粟粒型肺结核合并结核性脑膜脑炎的临床特点。方法回顾性分析2例急性粟粒型肺结核合并结核性脑膜脑炎患者的临床资料。结果本组患者为2例青年男性,分别为27、28岁,既往均无慢性结核感染的病史。2例患者临床表现主要为急性起病,高热、头痛,迅速出现严重的意识障碍,同时合并中枢神经系统实质受损。脑脊液检查呈细胞数、蛋白增高,显著低糖低氯化物的典型结核改变,胸部CT为双肺弥漫的大小、密度、分布均匀异常密度影,头部CT早期出现明显脑积水、细胞间质性水肿。临床诊断急性粟粒型肺结核合并结核性脑膜脑炎,抗结核治疗有效,但遗留了严重的神经系统后遗症。结论急性粟粒型肺结核血行感染中枢神经系统导致的结核性脑膜脑炎起病迅速,感染中毒症状极重,伴有中枢神经系统实质性损害,结核抗酸杆菌病原学检出率明显高于经典的结核性中枢神经系统感染,预后凶险。Objective To discuss clinical characteristics of acute miliary pulmonary tuberculosis compli- cating with tuberculous meningoencephalitis. Methods Retrospectively analysis clinical data of 2 cases with a- cute miliary pulmonary tuberculosis patients and tuberculous meningoencephalitis. Results Two patients were retrospectively 27, 28 years old young men without history of tuberculosis infection. Main clinical manifesta- tions were hyperpyrexia, headache, quickly deteriorateing into severe unconsciousness and involving CNS sub- stantial damage. CSF revealed increased number of cells, proteins, obvious low sugar and chloride changes. Chest CT was abnormal uniform distribution, size, density of pulmonary lesions and brain CT early appeared obvious hydrocephalus, interstitial edema. Clinical diagnosis was tuberculous meningoencephalitis and acute miliary pulmonary tuberculosis. Anti-tuberculosis curative effect was effective but serious sequelae were leaved. Conclusions The main clinical features of acute miliary pulmonary tuberculosis complicating with tu- berculous meningoencephalitis through blood circulation infection were rapid onset, severe infection toxic symptoms, accompanied with CNS substantial damage and critical prognosis. Acid bacillus tuberculosis detec- tion rate is significantly higher than classic CNS tuberculous infection.

关 键 词：结核性脑膜脑炎 急性粟粒型肺结核 结核T-Spot斑点试验 

分 类 号：R529.3[医药卫生—内科学]