免疫及分子技术助力诊断:黔北地区152例结核性脑膜炎患者临床特点分析  

Immunological and molecular technology assisting diagnosis: clinical characteristics analysis of 152 cases of tuberculous meningitis in northern Guizhou

作　　者：王涛 周亮[1] 杨红霞 唐书福 李娜娜 陈雪融 张建勇[1] WANGTao;ZHOU Liang;YANG Hongxia;TANG Shufu;LI Nana;CHENXuerong;ZHANG Jianyong(Second Department of Respiratory,Affiliated Hospital of Zunyi Medical College,Zunyi,Guizhou 563000,P.R.China;Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]遵义医学院第一附属医院呼吸二科,贵州遵义563000 [2]四川大学华西医院呼吸与危重症医学科,成都610041

出　　处：《华西医学》2018年第8期972-976,共5页West China Medical Journal

基　　金：贵州省科技计划项目(黔科合LH字[2016]7475号)

摘　　要：目的全面仔细地观察、认识、学习和理解结核性脑膜炎(tuberculous meningitis,TBM)的临床特点。方法回顾性分析2016年1月—2017年2月在遵义医学院第一附属医院呼吸二科住院治疗的152例TBM患者的一般资料、临床表现、临床检验检查及治疗预后等情况。结果 152例TBM患者平均年龄(43.9±20.4)岁,男女比例为1.45∶1,平均住院时间(20.0±18.9)d。临床表现以头痛[95.4%(145/152)]、恶心呕吐[42.8%(65/152)]、发热[61.8%(94/152)]为主。主要合并疾病为继发性肺结核[52.0%(79/152)]、血行播散性肺结核[37.5%(57/152)]、结核性胸膜炎[30.9%(47/152)]。γ-干扰素释放试验阳性率为90.8%(129/142),腰椎穿刺脑压升高,典型脑脊液生化改变为"低糖、低氯、高蛋白"。脑脊液结核菌涂片阳性率极低,脑脊液Gene Xpert MTB/RIF阳性率达21.9%(7/32)。患者易合并低蛋白血症,比例达29.6%(45/152),低钠血症比例达45.3%(69/152)。经早期诊断规范治疗,92.1%(140/152)好转出院。结论 TBM患者以青壮年为主,临床表现多样,呼吸道症状少,易合并肺结核及其他肺外结核,γ-干扰素释放试验和脑脊液Gene Xpert MTB/RIF可应用于结核病的辅助诊断。早发现早诊断早治疗,进行合理规范化学治疗,加强对症支持治疗,提高TBM的精准诊治,可改善其临床预后。Objective To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis（TBM）. Methods We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017. Results The mean age of the 152 patients with TBM was（43.9±20.4） years old, the ratio of male to female was 1.45：1, and the average length of hospital stay was（20.0±18.9）days. The clinical manifestations were mainly headache [95.4%（145/152）], nausea and vomiting [42.8%（65/152）], and fever [61.8%（94/152）]. The main co-morbidities were secondary pulmonary tuberculosis [52.0%（79/152）], hematogenous disseminated tuberculosis [37.5%（57/152）], and tuberculous pleurisy [30.9%（47/152）]. The positive rate of γ-interferon release test was 90.8%（129/142）, and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were ＂low glucose, low chlorine, and high protein＂. The positive rate of tuberculosis smear was extremely low, and the positive rate of Gene Xpert MTB/RIF in cerebrospinal fluid was 21.9%（7/32）. The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6%（45/152）, and the proportion of hyponatremia reached 45.3%（69/152）. Treated with early diagnosis and treatment, 92.1%（140/152） improved and discharged. Conclusions TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis.γ-interferon release test and cerebrospinal fluid Gene Xpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving

关 键 词：结核性脑膜炎 临床诊断 抗结核治疗 

分 类 号：R529.3[医药卫生—内科学]