中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2010年
5期
271-274
,共4页
朱敏%尹良胜%李锋%刘健仁
硃敏%尹良勝%李鋒%劉健仁
주민%윤량성%리봉%류건인
结核,脑膜%脑脊髓液%腺苷脱氨酶
結覈,腦膜%腦脊髓液%腺苷脫氨酶
결핵,뇌막%뇌척수액%선감탈안매
Tuberculosis,meningeal%Cerebrospinal fluid%Adenosine deaminase
目的 分析结核性脑膜炎(tuberculous meningitis,TBM)患者的临床特征及实验室检查特点,提高TBM早期诊断和治疗水平.方法 回顾分析1999年1月1日-2005年12月31日浙江省中西医结合医院结核病治疗中心收治的246例TBM患者的临床及实验室资料,应用SPSS 15.0软件进行统计分析.结果 246例TBM患者中,203例(82.5%)为颅底脑膜炎型,170例(69.1%)患者合并肺结核,临床症状以发热、恶心呕吐、头痛为主.155例(63.0%)患者结核菌素(PPD)试验阳性,仅12例(4.9%)患者脑脊髓液涂片抗酸杆菌阳性.脑脊髓液检查白细胞升高[(320～880)×106/L],分类以淋巴细胞为主(≥95%),蛋白升高(0.95-13.8 g/L),糖(1.53～3.20 mmol/L)和氯化物(90～111 mmol/L)含量降低.93.5%(230/246)的患者脑脊髓液检查腺苷脱氨酶≥8 U/L,75.2%(185/246)的患者结核抗体阳性.81例(32.9%)具有脑部影像学改变,以结节状和环状阴影为主.242例患者经过综合治疗有效,总有效率为98.4%,4例患者死亡,病死率为1.6%.结论 综合分析临床表现、脑脊髓液改变、影像学检查结果以及PPD试验是早期诊断TBM的有效方法.
目的 分析結覈性腦膜炎(tuberculous meningitis,TBM)患者的臨床特徵及實驗室檢查特點,提高TBM早期診斷和治療水平.方法 迴顧分析1999年1月1日-2005年12月31日浙江省中西醫結閤醫院結覈病治療中心收治的246例TBM患者的臨床及實驗室資料,應用SPSS 15.0軟件進行統計分析.結果 246例TBM患者中,203例(82.5%)為顱底腦膜炎型,170例(69.1%)患者閤併肺結覈,臨床癥狀以髮熱、噁心嘔吐、頭痛為主.155例(63.0%)患者結覈菌素(PPD)試驗暘性,僅12例(4.9%)患者腦脊髓液塗片抗痠桿菌暘性.腦脊髓液檢查白細胞升高[(320～880)×106/L],分類以淋巴細胞為主(≥95%),蛋白升高(0.95-13.8 g/L),糖(1.53～3.20 mmol/L)和氯化物(90～111 mmol/L)含量降低.93.5%(230/246)的患者腦脊髓液檢查腺苷脫氨酶≥8 U/L,75.2%(185/246)的患者結覈抗體暘性.81例(32.9%)具有腦部影像學改變,以結節狀和環狀陰影為主.242例患者經過綜閤治療有效,總有效率為98.4%,4例患者死亡,病死率為1.6%.結論 綜閤分析臨床錶現、腦脊髓液改變、影像學檢查結果以及PPD試驗是早期診斷TBM的有效方法.
목적 분석결핵성뇌막염(tuberculous meningitis,TBM)환자적림상특정급실험실검사특점,제고TBM조기진단화치료수평.방법 회고분석1999년1월1일-2005년12월31일절강성중서의결합의원결핵병치료중심수치적246례TBM환자적림상급실험실자료,응용SPSS 15.0연건진행통계분석.결과 246례TBM환자중,203례(82.5%)위로저뇌막염형,170례(69.1%)환자합병폐결핵,림상증상이발열、악심구토、두통위주.155례(63.0%)환자결핵균소(PPD)시험양성,부12례(4.9%)환자뇌척수액도편항산간균양성.뇌척수액검사백세포승고[(320～880)×106/L],분류이림파세포위주(≥95%),단백승고(0.95-13.8 g/L),당(1.53～3.20 mmol/L)화록화물(90～111 mmol/L)함량강저.93.5%(230/246)적환자뇌척수액검사선감탈안매≥8 U/L,75.2%(185/246)적환자결핵항체양성.81례(32.9%)구유뇌부영상학개변,이결절상화배상음영위주.242례환자경과종합치료유효,총유효솔위98.4%,4례환자사망,병사솔위1.6%.결론 종합분석림상표현、뇌척수액개변、영상학검사결과이급PPD시험시조기진단TBM적유효방법.
Objective To review the clinical and laboratory features of tuberculous meningitis (TBM). Methods The clinical and laboratory data from 246 cases of TBM in Tuberculosis Treatment Center of Integrated Chinese and Western Medicine Hospital of Zhejiang Province from January 1,1999 to December 31,2005 were collected and analyzed with SPSS 15.0 software. Results In 246 TBM patients,203(82.5%)was of basilar meningitis, 170(69. 1%)complicated with pulmonary tuberculosis. Fever,nausea, vomiting and headache were common symptoms in TBM patients. PPD skin tests were positive in 155(63.0%)patients, but only 12(4.9%)were acid-fast bacillus smear-positive in cerebrospinal fluid (CSF). CSF test showed that the white blood cells[(320 - 880)× 106/L], protein(0. 95 - 13.8 g/L)were increased, while glucose(1.53 - 3.2 mmol/L)and chloride content(90 - 111 mmol/L)were decreased. Adenosine deaminase ≥8 U/L was observed in 230(93.5%)patients, and 185(75.2%)patients were tuberculosis antibody positive. Eighty-one(32. 9%)patients showed nodular or annular shadows in cranial CT. After comprehensive therapy, 242(98.4%)patients recovered or improved and no sequela was observed, while 4(1.6%)patients died. Conclusion Early diagnosis of TBM should be based on clinical manifestations, changes of cerebrospinal fluid, imaging examination and PPD test.
