中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2013年
2期
93-96
,共4页
林仕忠%张彦亮%金嘉琳%陈澍%翁心华
林仕忠%張彥亮%金嘉琳%陳澍%翁心華
림사충%장언량%금가림%진주%옹심화
结核,脑膜%颅神经损伤%意识障碍%预后
結覈,腦膜%顱神經損傷%意識障礙%預後
결핵,뇌막%로신경손상%의식장애%예후
Tuberculosis,meningeal%Cranial nerve injuries%Consciousness disorders%Prognosis
目的 了解结核性脑膜炎患者并发颅神经损伤的相关危险因素.方法 回顾性分析复旦大学附属华山医院2000年至2011年住院治疗的结核性脑膜炎病例共121例,收集患者性别、年龄、病程等一般资料和首次脑脊液检查结果、颅神经损伤发生情况及转归.所有患者至少随访3个月,对合并颅神经损伤患者,随访时间至少1年,以判断神经损伤是否恢复.相关危险因素分析采用Logistic逐步回归法.结果 121例患者中22例出现颅神经损伤,发生率为18.2％,其中外展神经、动眼神经、视神经、听神经受累者分别为9例(40.9％)、8例(36.4％)、7例(31.8％)、1例(4.5％).1组以上颅神经受累患者共3例,占发生颅神经受损患者的13.6％.颅神经损伤患者较无损伤患者意识障碍发生率明显升高(77％比45％,P=0.020).确诊时间延长(OR=1.017,95CI为1.001～1.033,P=0.040)和意识障碍(OR=3.242,95％CI为1.142～9.205,P=0.027)是发生颅神经损伤的独立预测因素.发生颅神经损伤后有20例(90.9％)患者可以完全恢复,恢复的中位时间为1个月(0.5～6.0个月).结论 颅神经损伤在结核性脑膜炎患者中较常见,确诊时间延长以及意识障碍的出现是预测因素.颅神经损伤大部分是可逆性改变,及时诊断及治疗是减少并发症的重要手段.
目的 瞭解結覈性腦膜炎患者併髮顱神經損傷的相關危險因素.方法 迴顧性分析複旦大學附屬華山醫院2000年至2011年住院治療的結覈性腦膜炎病例共121例,收集患者性彆、年齡、病程等一般資料和首次腦脊液檢查結果、顱神經損傷髮生情況及轉歸.所有患者至少隨訪3箇月,對閤併顱神經損傷患者,隨訪時間至少1年,以判斷神經損傷是否恢複.相關危險因素分析採用Logistic逐步迴歸法.結果 121例患者中22例齣現顱神經損傷,髮生率為18.2％,其中外展神經、動眼神經、視神經、聽神經受纍者分彆為9例(40.9％)、8例(36.4％)、7例(31.8％)、1例(4.5％).1組以上顱神經受纍患者共3例,佔髮生顱神經受損患者的13.6％.顱神經損傷患者較無損傷患者意識障礙髮生率明顯升高(77％比45％,P=0.020).確診時間延長(OR=1.017,95CI為1.001～1.033,P=0.040)和意識障礙(OR=3.242,95％CI為1.142～9.205,P=0.027)是髮生顱神經損傷的獨立預測因素.髮生顱神經損傷後有20例(90.9％)患者可以完全恢複,恢複的中位時間為1箇月(0.5～6.0箇月).結論 顱神經損傷在結覈性腦膜炎患者中較常見,確診時間延長以及意識障礙的齣現是預測因素.顱神經損傷大部分是可逆性改變,及時診斷及治療是減少併髮癥的重要手段.
목적 료해결핵성뇌막염환자병발로신경손상적상관위험인소.방법 회고성분석복단대학부속화산의원2000년지2011년주원치료적결핵성뇌막염병례공121례,수집환자성별、년령、병정등일반자료화수차뇌척액검사결과、로신경손상발생정황급전귀.소유환자지소수방3개월,대합병로신경손상환자,수방시간지소1년,이판단신경손상시부회복.상관위험인소분석채용Logistic축보회귀법.결과 121례환자중22례출현로신경손상,발생솔위18.2％,기중외전신경、동안신경、시신경、은신경수루자분별위9례(40.9％)、8례(36.4％)、7례(31.8％)、1례(4.5％).1조이상로신경수루환자공3례,점발생로신경수손환자적13.6％.로신경손상환자교무손상환자의식장애발생솔명현승고(77％비45％,P=0.020).학진시간연장(OR=1.017,95CI위1.001～1.033,P=0.040)화의식장애(OR=3.242,95％CI위1.142～9.205,P=0.027)시발생로신경손상적독립예측인소.발생로신경손상후유20례(90.9％)환자가이완전회복,회복적중위시간위1개월(0.5～6.0개월).결론 로신경손상재결핵성뇌막염환자중교상견,학진시간연장이급의식장애적출현시예측인소.로신경손상대부분시가역성개변,급시진단급치료시감소병발증적중요수단.
Objective To investigate the risk factors associated with cranial nerve impairment in patients with tuberculous meningitis.Methods A total of 121 patients with tuberculous meningitis who were admitted to Huashan Hospital from 2000 to 2011 were reviewed retrospectively.Demographic data (gender,age),course of disease,initial results of cerebral spinal fluid (CSF) tests,occurrence of cranial nerve impairment and prognosis of these patients were collected.All the patients were followed up for at least 3 months,and for those with cranial nerve impairment,the minimum follow-up period was 1 year in order to judge the recovery of cranial nerve impairment.Multivariate analysis was performed to study the associated risk factors.Results Out of 121 patients,22 (18.2 ％)developed cranial nerve impairment.Nerves involved were abducens nerve,oculomotor nerve,optic nerve and auditory nerve,and impairment of single nerve occurred in 9 (40.9 ％),8 (36.4 ％),7(31.8％) and 1(4.5％) patient,respectively.Three cases had more than one group of cranial nerves involved,accounting for 13.6％ of the 22 patients with cranial nerve impairment.The incidence of conscious disturbance was significantly higher in patients with cranial nerve impairment than those without impairment (77 ％ vs 45 ％,P=0.020).Delay in diagnosis (OR =1.017,95 ％ CI:1.001-1.033,P=0.040) and occurrence of conscious disturbance (OR =3.242,95 ％ CI:1.142-9.205,P=0.027) were independent predictive factors of cranial nerve injury.During one-year follow-up,90.9％ of patients were fully recovered from cranial nerve impairment,with a median duration of 1 month (range 0.5-6.0 months).Conclusions Cranial nerve impairment is a common complication in patients with tuberculous meningitis.Delay in diagnosis and occurrence of conscious disturbance were independent predictive factors.Most cranial nerve impairment were reversible,and timely diagnosis and treatment are important ways to reduce complications.
