无神经系统症状/体征的肺结核合并结核性脑膜炎患儿早期临床特征分析  

Analysis of early clinical characteristics in pediatric patients with pulmonary tuberculosis complicated with tuberculous meningitis without neurological symptoms or signs

作　　者：郑圣坤 黄绍梅[1] 马尚明 郭慧莲 ZHENG Shengkun;HUANG Shaomei;MA Shangming;GUO Huilian(Pediatric Department,Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院儿科,广东广州510095

出　　处：《山东医药》2025年第4期16-20,共5页Shandong Medical Journal

基　　金：广东省广州市卫生健康科技一般引导项目(20251A010030)。

摘　　要：目的分析无神经系统症状/体征的肺结核(PTB)合并结核性脑膜炎(TBM)患儿的早期临床特征,为临床诊疗提供参考。方法回顾性收集初诊初治PTB合并TBM患儿84例,其中无神经系统症状/体征的PTB合并TBM(NS-PTB-TBM)患儿46例(NS-PTB-TBM组),有神经系统症状/体征的PTB合并TBM(S-PTB-TBM)患儿38例(S-PTB-TBM组)。比较两组一般资料、实验室及影像学检查等相关临床指标,采用多因素Logistic回归分析PTB合并TBM患儿不表现出神经系统症状/体征的影响因素。结果NS-PTB-TBM组年龄≥10岁比例、咳嗽比例、营养不良比例、白细胞计数≥12×109/L比例及外周血C反应蛋白(CRP)、乳酸脱氢酶、球蛋白、腺苷脱氨酶(ADA)水平均高于S-PTB-TBM组,外周血白蛋白、高密度脂蛋白水平均低于S-PTB-TBM组(P均<0.05)。NS-PTB-TBM组痰/胃液MTB涂片、核酸阳性率及小叶中心结节、树芽征、肺门/纵隔淋巴结肿大、弥漫粟粒改变比例均高于S-PTB-TBM组,钙化比例低于S-PTB-TBM组(P均<0.05)。多因素Logistic分析结果显示,咳嗽、CRP升高、ADA升高是促进初诊初治时PTB合并TBM患儿不表现出神经系统症状/体征的独立危险因素。结论NS-PTB-TBM患儿在初诊初治时表现出更活跃的炎症反应和特定的影像学特征,外周血CRP和ADA水平升高可能是患儿不表现出神经系统症状/体征的独立危险因素。Objective To investigate the early clinical characteristics of pediatric patients with pulmonary tuberculo-sis(PTB)complicated with tuberculous meningitis(TBM)who exhibit no neurological symptoms or signs,in order to pro-vide a reference for clinical diagnosis and treatment.Methods A retrospective study was conducted on 84 pediatric pa-tients newly diagnosed and initially treated for PTB complicated with TBM.Patients were classified into two groups:those without neurological symptoms/signs(NS-PTB-TBM group,n=46)and those with neurological symptoms/signs(S-PTB-TBM group,n=38).Demographic characteristics,laboratory test results,and radiological findings were compared be-tween the groups.Multivariate Logistic regression analysis was used to identify the factors associated with the absence of neurological symptoms/signs in pediatric patients with PTB complicated with TBM.Results Compared with the S-PTB-TBM group,the NS-PTB-TBM group exhibited significantly higher proportions of patients aged≥10 years,cough,malnu-trition,white blood cell counts≥12×109/L,and elevated peripheral blood levels of C-reactive protein(CRP),lactic de-hydrogenase,globulin,and adenosine deaminase(ADA);conversely,albumin and high-density lipoprotein(HDL)lev-els were significantly lower in the NS-PTB-TBM group(all P<0.05).Radiological evaluations demonstrated higher positiv-ity rates for sputum/gastric aspirate Mycobacterium tuberculosis(MTB)smear and nucleic acid amplification tests in the NS-PTB-TBM group,alongside increased frequencies of centrilobular nodules,tree-in-bud signs,hilar/mediastinal lymph-adenopathy,and diffuse miliary changes,and with a lower incidence of calcification(all P<0.05).Multivariate Logistic regression analysis revealed cough,elevated CRP,and elevated ADA were independent factors for the absence of neurolog-ical symptoms/signs at initial diagnosis.Conclusions Pediatric patients with NS-PTB-TBM exhibit more active inflam-matory responses and distinct radiological features at initial diagnosis and treatment.Elevated

关 键 词：肺结核 结核性脑膜炎 神经系统症状 早期诊断 儿童疾病 

分 类 号：R725.6[医药卫生—儿科]