结核性脑膜炎诊治现状及进展  

Current Situation and Progress of Diagnosis and Treatment in Tuberculous Meningitis

作　　者：黄四春[1] 张忠胜[1] 

机构地区：[1]广东省清远市人民医院脑科二区,511518

出　　处：《中国全科医学》2016年第B12期217-220,共4页Chinese General Practice

摘　　要：结核性脑膜炎(TBM)是感染结核分枝杆菌所致疾病最严重的形式,半数患者死亡或者致残。即使抗结核治疗,仍然有半数以上的TBM患者死亡或者遗留神经系统后遗症;因为早期症状缺乏特异性及脑脊液载菌量较少,早期进行TBM诊断仍然困难,所以抗结核治疗通常是延迟的。TBM早期诊断和早期治疗是决定预后的最重要的因素。依据临床特点、脑脊液特点和影像学检查(颅脑CT/MRI、胸部CT等),仍然是早期诊断的关键。抗结核和激素治疗能够减少病死率,但并没有改善患者严重的残疾,使其遗留长期卧床和严重的生活不能自理;脑梗死是TBM患者常见并发症,急性期应用阿司匹林能否进一步降低病死率及改善严重的残疾尚待进一步明确。本文将对TBM的病理特点、诊断及治疗作一综述。Tuberculous meningitis （TBM） is the most severe form of infection caused by Mycobacterium tuberculosis, causing death or disability in more than half of those affected. The diagnosis of TBM remains difficult as its presentation is non - specific and may mimic other causes of chronic menin - goencephalitis. Rapid recognition of TBM is crucial, however, as delays in initiating treatment are associated with poor outcome. Based on clinical characteristics, the characteristics of cerebrospinal fluid and imaging studies （ craniocerebral CT/MRI, chest CT, etc. ） , is still the key to early diagnosis. Adjunctive treatment with corticosteriods improves survival in patients with tuberculous meningitis but probably does not prevent severe disability. Cerebral infarction is a common complication in patients with TBM, whether application of aspirin in the acute phase can reduce mortality and improve serious disability is yet to be further defined. The aim of this review is to examine recent advances in our understanding of TBM.

关 键 词：结核 脑膜 抗结核药 激素类 阿司匹林 综述 

分 类 号：R529.3[医药卫生—内科学]