儿童结核性脑膜炎近期预后的影响因素分析  

The influencing factors analysis of short-term prognosis in children with tuberculous meningitis

作　　者：乔凯[1] 尚丹鹤[1] 贾宝辉[2] QIAO Kai;SHANG Danhe;JIA Baohui(The Sixth People's Hospital of Zhengzhou,Zhengzhou 450000,China;Zhengzhou Central Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第六人民医院,河南郑州450000 [2]郑州市中心医院,河南郑州450000

出　　处：《中国实用神经疾病杂志》2019年第9期993-999,共7页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81760353)

摘　　要：目的调查儿童结核性脑膜炎的基本资料,分析该疾病近期预后的影响因素。方法选择136例结核性脑膜炎患儿作为研究对象,采取回顾性研究方法了解患儿的基本资料,Logistic回归分析确定儿童结核性脑膜炎近期预后的影响因素。结果结核性脑膜炎患儿年龄分布<3岁39例(28.68%),3~6岁51例(37.50%),>6岁46例(33.82%);男78例,女58例,男女性别比为1.34:1;临床症状和体征以发热(117例,86.03%)、头痛(72例,52.94%)、呕吐(41例,30.15%)、脑膜刺激症阳性(46例,33.82%)、Babinski征阳性(33例,24.26%)、肌力降低(28例,20.59%)为主;临床分期为早期26例(19.12%)、中期67例(49.26%)和晚期43例(31.62%);脑部MRI检查脑水肿44例(32.35%),脑实质改变70例(51.47%);脑脊液检查指标中白细胞数、蛋白质量、葡萄糖量以及氯化物量异常例数分别为115例(84.56%)、102例(75.00%)、91例(66.91%)和95例(69.85%);加用糖皮质激素106例(77.94%),加用鞘内注射93例(68.38%);近期预后良好者81例(59.56%),预后不良者55例(40.44%)。结核性脑膜炎患儿预后不良的独立危险因素包括临床分期晚期(OR=3.823,95%CI:1.246~11.730)、脑膜刺激症阳性(OR=2.030,95%CI:1.093~3.771)以及脑水肿(OR=2.765,95%CI:1.174~6.511)(P均<0.05)。结论儿童结核性脑膜炎的近期预后与许多因素有关,临床分期晚期以及脑水肿是预后不良的主要危险因素,对于疾病治疗和病情监测具有重要意义。Objective To investigate the basic data of children with tuberculous meningitis and to analyze the influencing factors of short-term prognosis.Methods 136 children with tuberculous meningitis were selected as study objects.The basic data of children was graped by retrospective study and the influencing factors of short-term prognosis were analyed by logistic regression analysis.Results There were 39 cases aged<3 years old(accounting for 28.68%),51 cases aged 3~6 years old(accounting for 37.50%)and 46 cases aged>6 years old(accounting for 33.82%),and there were 78 males and females 58 cases(the ratio was 1.34:1).The clinical symptoms and signs included fever(117 cases,86.03%),headache(72 cases,52.94%),vomiting(41 cases,30.15%),meningeal irritation(46 cases,33.82%),babinski sign positive(33 cases,24.26%)and decreased muscle strength(28 cases,20.59%).Clinical stages included 26 cases in the early stage,67 cases in the middle stage and 43 cases in the late stage.There were 44 cases of brain edema and 70 cases of brain parenchyma changes by brain MRI examination.The number of abnormal cases of white blood cells,protein,glucose and chloride in the cerebrospinal fluid was respectively 115(accounting for 84.56%),102(accounting for 75.00%),91(accounting for 66.91%),and 95 cases(accounting for 69.85%).There were 106 cases with glucocorticoids,93 cases with intrathecal injection.136 cases were divided into good prognosis group(81 cases)and poor prognosis group(55 cases)Logistic regression analysis showed that late clinical stage(OR=3.823,95%CI:1.246~11.730),meningeal irritation(OR=2.030,95%CI:1.093~3.771)and brain edema(OR=2.765,95%CI:1.174~6.511)were the risk factors for short-term prognosis of children tuberculous meningitis(P<0.05).Conclusion The short-term prognosis of tuberculous meningitis in children was related to many factors.Late clinical stage and cerebral edema were the main risk factors for poor prognosis,having great significance for disease treatment and disease monitoring.

关 键 词：结核性脑膜炎 儿童 预后 影响因素 

分 类 号：R512.3[医药卫生—内科学]