重症结核性脑膜炎预后不良影响因素分析  

Analysis of influencing factors of dismal prognosis in severe tuberculous meningitis

作　　者：刘臣超 刘慧权[1,3] 袁小勇 王健[1,3] 陈绅 王义义[2,3] 柳兴军 LIU Chen-chao;LIU Hui-quan;YUAN Xiao-yong;WANG Jian;CHEN Shen;WANG Yi-yi;LIU Xing-jun(Department of Neurosurgery,,Tianjin Haihe Hospital,Tianjin 300350,China;Department of Neurology,Tianjin Haihe Hospital,Tianjin 300350,China;Traditional Chinese Medicine Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine,Tianjin 300350,China)

机构地区：[1]天津市海河医院神经外科,300350 [2]天津市海河医院神经内科,300350 [3]国家中医药管理局中医药防治传染病重点研究室,300350

出　　处：《中国现代神经疾病杂志》2023年第6期522-529,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市医学重点学科(专科)建设项目(项目编号:TJYXZDXK-067C);天津市卫生健康科技项目(项目编号:ZC20145)。

摘　　要：目的 探讨重症结核性脑膜炎患者远期预后相关影响因素。方法 纳入2012年6月至2019年12月在天津市海河医院行抗结核治疗的163例重症结核性脑膜炎患者,治疗后1年采用改良Rankin量表(mRS)评价预后,单因素和多因素逐步法Logistic回归分析筛查重症结核性脑膜炎患者远期预后不良相关影响因素,并绘制受试者工作特征曲线(ROC曲线)评价其对预后的预测价值。结果 根据mRS评分分为预后良好组(mRS评分≤2分,95例)和预后不良组(mRS评分> 2分,68例)。预后不良组患者年龄(t=-5.884,P=0.000),高血压(χ^(2)=15.769,P=0.000)、冠心病(校正χ^(2)=6.785,P=0.009)、四肢无力(χ^(2)=9.544,P=0.002)、脑积水(χ^(2)=23.004,P=0.000)、脑梗死(χ^(2)=17.417,P=0.000)比例,脑脊液乳酸(Z=-2.405,P=0.016)均高于预后良好组,入院时Glasgow昏迷量表(GCS)评分低于预后良好组(Z=-6.750,P=0.000)。Logistic回归显示,高龄(OR=1.064,95%CI:1.031~1.098;P=0.000)和脑脊液高乳酸水平(OR=1.404,95%CI:1.065~1.852;P=0.016)是重症结核性脑膜炎患者远期预后不良的危险因素,入院时高GCS评分是远期预后良好的保护因素(OR=0.539,95%CI:0.405~0.716;P=0.000)。进一步绘制ROC曲线,年龄、入院时GCS评分和脑脊液乳酸水平预测重症结核性脑膜炎患者远期预后不良的截断值分别为48.50岁、12.50分和6.99 mmol/L,曲线下面积分别为0.743(95%CI:0.665~0.822,P=0.000)、0.802(95%CI:0.732~0.871,P=0.000)和0.611(95%CI:0.517~0.704,P=0.016),灵敏度和特异度分别为63.20%和76.80%、58.80%和86.30%、42.60%和91.60%;上述3项指标联合应用的曲线下面积为0.892(95%CI:0.841~0.944,P=0.000),灵敏度为80.90%、特异度88.40%,其预测效能优于单一指标。结论 高龄和脑脊液高乳酸水平是重症结核性脑膜炎患者远期预后不良的危险因素,入院时高GCS评分为保护因素,临床医师应重点关注这些因素以改善患者预后。Objective To investigate the influencing factors related to long-term prognosis in patients with severe tuberculous meningitis(TBM).Methods One hundred sixty-three patients with severe TBM admitted to Tianjin Haihe Hospital from June 2012 to December 2019 were included.After one year of anti-tuberculous therapy,the prognosis of the patients was evaluated by modified Rankin Scale(mRS).Univariate and multivariate stepwise Logistic regression analyses were used to analyze the influencing factors of long-term dismal prognosis of severe TBM.The predictive value was evaluated by receiver operating characteristic(ROC)curve.Results In the dismal prognosis group(mRS>2,n=68),patients'age(t=-5.884,P=0.000),hypertension(χ^(2)=15.769,P=0.000),coronary heart disease(adjustedχ^(2)=6.785,P=0.009),limb weakness(χ^(2)=9.544,P=0.002),hydrocephalus(χ^(2)=23.004,P=0.000),cerebral infarction(χ^(2)=17.417,P=0.000),cerebrospinal fluid(CBF)lactic acid level(Z=-2.405,P=0.016)were higher than those in favourable prognosis group(mRS≤2,n=95),while Glasgow Coma Scale(GCS)score on admission was lower than that in favourable prognosis group(Z=-6.750,P=0.000).Logistic regression showed that old age(OR=1.064,95%CI:1.031-1.098;P=0.000)and high CSF lactic acid level(OR=1.404,95%CI:1.065-1.852;P=0.016)were risk factors for long-term dismal prognosis of severe TBM,and high GCS score on admission was a protective factor for long-term favourable prognosis of severe TBM(OR=0.539,95%CI:0.405-0.716;P=0.000).ROC curve showed the cut-off value of age for predicting long-term dismal prognosis of severe TBM on admission was 48.50 years,the area under the curve(AUC)was 0.743(95%CI:0.665-0.822,P=0.000),the sensitivity was 63.20%and the specificity was 76.80%.The cut-off value of GCS score was 12.50,the AUC was 0.802(95%CI:0.732-0.871,P=0.000),the sensitivity was 58.80%and the specificity was 86.30%.The cut-off value of lactic acid level in CSF was 6.99 mmol/L,the AUC was 0.611(95%CI:0.517-0.704,P=0.016),the sensitivity was 42.60%and the specificity was 9

关 键 词：结核 脑膜 预后 危险因素 LOGISTIC模型 

分 类 号：R529.3[医药卫生—内科学]