结核性脑膜炎临床特点 脑脊液及影像学表现的相关研究  

Research on clinical features,MRI manifestations and changes of cerebrospinal fluid of tubercular meningitis

作　　者：李军霞[1] 陈颜强[1] 赵青[1] 何红彦[1] 孟艺哲 

机构地区：[1]河北省胸科医院神经内科,石家庄050000

出　　处：《中国实用神经疾病杂志》2017年第10期23-26,共4页Chinese Journal of Practical Nervous Diseases

基　　金：2016年度河北省卫计委医学科学研究重点课题计划;编号:20160491

摘　　要：目的探讨结核性脑膜炎的临床特点、脑脊液及影像学表现。方法收集我院2011-10-2015-10符合条件的结核性脑膜炎75例患者,分析其临床特点、脑脊液指标动态变及磁共振表现等特征。结果除常见的发热、头痛、呕吐等主诉外,30%患者以咳嗽、咳痰、气短等脑外结核症状首诊;79%患者仍被误诊为病毒性脑膜炎;TBM经抗结核治疗后,脑脊液氯化物率先恢复,其后为蛋白、葡萄糖、ADA,而颅压及细胞数恢复最慢;结核性脑膜炎脑实质及脑膜均可受累,头颅MRI平扫检查阳性率80%,增强扫描阳性率96.9%。结论结核性脑膜炎易误诊为病毒性脑膜炎;TBM为多器官疾病,临床上应积极寻找脑外结核部位;MRI可较早发现TBM特征性病灶,且阳性率较高;临床上怀疑TMB时应尽可能利用多种现代技术寻找脑脊液中抗酸杆菌,为结脑诊断提供病原学依据。Objective To explore clinical features,MRI manifestations and changes of cerebrospinal fluid （CSF） of tubercu- lar meningitis（TBM）. Methods We summarized the clinical features,MRI characteristics and dynamic indicators of CSF of 75 ca- ses with TBM treated in our hospital from October 2011 to October 2015. Results Thirty percent of the included cases presented cough,expectoration,shortness of breath and other ex-brain tuberculosis symptoms as initial-visit symptoms, except for fever, headache,emesis and other complains. 79 % cases were misdiagnosed as virus meningitis. After anti-tuberculosis medications,chlo- ride level at first recovered, followed by protein, glucose and ADA levels, and intracranial pressure and cell population renewed most slowly. In addition,both brain parenchyma and meninges were affected in TBM patients. Brain MRI scan showed positive rate of 80% and enhancement scan showed positive rate of 96.9%. Conclusion Tubercular meningitis which is a multi-organ disease may be easily misdiagnosed as virus meningitis. It is necessary to actively seek ex-brain tuberculosis locations. MRI may early find out characteristic focus with high positive rate. More and more simple and noninvasive modern technology should be applied to look for acid-fast bacilli of CSF, providing etiological evidences for diagnosis.

关 键 词：结核性脑膜炎 早期诊断 磁共振表现 脑脊液 

分 类 号：R529.3[医药卫生—内科学]