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经过长期的医疗实践,结核性脑膜炎(TBM)病人的预后有了很大改善。但一些病人由于诊断延误和治疗不当,仍不免致残或死亡。TBM的基本疗法很简单,和其他脏器的结核病一样,开始治疗时需联用至少3种药物以防病情恶化和产生耐药菌株。疗程应持续到彻底治愈。但本病的治疗还有两项要求:选择的药物应通过并能持续通过血脑屏障;应尽早开始治疗以防止或减轻粘连。抗生素疗法治疗其他脏器结核的药物对TBM不完全适用。异烟肼、吡嗪酰胺和环丝氨酸能自由通过血脑屏障,但对其他药物(利福平、乙胺丁醇和链霉素)通过血脑屏障的情况所知较少。某些证据表明,多数病人在患病前2～3个月内,利福平和乙胺丁醇在脑脊液中可达足够的浓度,但不清楚在治疗过程中血脑屏障恢复正常时此种浓度能保持
After long-term medical practice, the prognosis of patients with tuberculous meningitis (TBM) has been greatly improved. However, some patients are still suffering from malaise or death due to delayed diagnosis and improper treatment. The basic therapy for TBM is as simple as tuberculosis in other organs. At least three medications should be given at the start of treatment to prevent the disease from deteriorating and produce resistant strains. Treatment should be continued until completely cured. There are, however, two additional requirements for the treatment of this disease: the drug of choice should pass through and continue to pass through the blood-brain barrier; treatments should be started as soon as possible to prevent or reduce adhesions. Antibiotic therapies for other organ tuberculosis drugs are not entirely suitable for TBM. Isoniazid, pyrazinamide and cycloserine are free to cross the blood-brain barrier, but to the lesser extent they are known to cross the blood-brain barrier for other drugs (rifampin, ethambutol and streptomycin). There is some evidence that most patients have adequate concentrations of rifampicin and ethambutol in cerebrospinal fluid within 2 to 3 months prior to their illness, but it is unclear when such a level of blood-brain barrier returned to normal during treatment Can keep