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背景:对结核性脑膜炎(TBM)的就诊、诊断、治疗和转归的前瞻性观察研究。方法:对结核性脑膜炎患者的人口学资料、临床信息、治疗及转归进行随访。确诊后3年内每6个月对转归资料核实1次。对死亡和完全康复的预后因素分别进行多因素COX和logistic回归模型分析。结果:1993-2000年共入选结核性脑膜炎患者166例。患者平均年龄42.9岁,其中中国公民153例,男性81例;92%的患者接受了HRZS(H=异烟肼;R=利福平;Z=吡嗪酰胺;S=链霉素),HRZE(E=乙胺丁醇)或HRZES方案治疗。应用激素的有105例,激素对转归无明显影响。3年随访结束,完全康复110例,残疾20例,死亡26例。死亡与就诊时年老、脑脊液淋巴细胞低下及意识水平差有显著的相关性。完全康复与年轻、女性及无合并症有相关性。结论:随访至3年,香港结核性脑膜炎治疗转归较好,病死率为15.7(26/166)。早发现,早确诊和使用有效的治疗方案可能是降低死亡率和发病率最重要的因素。
Background: A prospective observational study of the presentation, diagnosis, treatment and outcome of tuberculous meningitis (TBM). Methods: The demographic data, clinical information, treatment and prognosis of patients with tuberculous meningitis were followed up. 3 years after the diagnosis of the outcome of every 6 months to verify the information once. Multivariate COX and logistic regression models were used to analyze the prognostic factors of death and complete recovery respectively. Results: A total of 166 patients with tuberculous meningitis were selected from 1993 to 2000. The mean age of patients was 42.9 years, of whom 153 were Chinese citizens and 81 were males. 92% of patients received HRZS (H = isoniazid; R = rifampin; Z = pyrazinamide; S = streptomycin) (E = ethambutol) or HRZES regimen. There are 105 cases of hormone application, hormones no significant effect on the outcome. Three years of follow-up, complete recovery of 110 cases, 20 cases of disability, 26 deaths. There was a significant correlation between death and age at presentation, low cerebrospinal fluid lymphocyte and poor awareness level. Full recovery is related to young, female and noncomparable. CONCLUSION: Follow-up to 3 years, the treatment of tuberculous meningitis in Hong Kong has a better outcome with a case-fatality rate of 15.7 (26/166). Early detection and early diagnosis and use of effective treatment options may be the most important factor in reducing mortality and morbidity.