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目的探讨结核性脑膜炎(TBM)临床特点。方法回顾性分析1980—2008年经临床诊断住院TBM病人366例,采用SPSS 11.5统计学软件,对其病历资料进行分析。结果(1)近10年来TBM住院病例有增多趋势,主要是农民工TBM的增多占41.0%(87/212)。(2)脑脊液(CSF)培养结核菌321例,阳性28例;涂片60例,阳性4例。(3)颅脑MRI、CT检查异常最常见部位是基底节区70例(59.3%),合并脑积水76例(64.4%)。MRI影像异常发现率84.7%,主要表现为斑片、小结节、环状异常信号,T1W1呈等或低信号,T2W1、FLAIR呈高信号;CT影像异常发现率69.6%,主要表现为斑片、小灶状低密度影、脑室扩张、脑积液等。颅脑增强扫描渗出性病变呈环状强化是TBM的特征性表现。(4)TBM病死率14.2%,死亡原因:脑疝30例(57.7%)、感染性休克10例(19.2%)、全身衰竭3例(5.77%)、消化道出血3例(5.77%)。(5)≤14岁组126例中本地78例,卡介苗接种史12例,农民工子女48例,卡介苗接种史3例。结论提高CSF分枝杆菌的检出率对提高TBM诊断水平十分重要;MRI检查对TBM诊断有重要意义;对脑疝的抢救、有效抗感染、营养支持、防治消化道出血等是TBM治疗成败的关键;需重视卡介苗接种和接种质量。
Objective To investigate the clinical features of tuberculous meningitis (TBM). Methods A retrospective analysis of 366 cases of TBM inpatients diagnosed from 1980 to 2008 in our hospital was conducted. SPSS 11.5 statistical software was used to analyze the medical record data. Results (1) There is an increasing trend of TBM in the past 10 years. The main reason is the increase of migrant workers TBM 41.0% (87/212). (2) Cerebrospinal fluid (CSF) culture Mycobacterium tuberculosis 321 cases, 28 were positive; smear 60 cases, 4 were positive. (3) The most common sites of brain MRI and CT examination were basal ganglia in 70 cases (59.3%) and hydrocephalus in 76 cases (64.4%). The abnormal MRI findings were found in 84.7% of the cases, mainly in the form of patch, nodules and annular abnormalities. T1W1 showed equal or low signal intensity, while T2W1 and FLAIR showed high signal. The abnormal CT findings were 69.6% , Small lesions like low density, ventricular dilatation, hydrocephalus and so on. Brain enhancement scan Exudative lesions ring enhancement is a characteristic manifestation of TBM. (4) The mortality rate of TBM was 14.2%. The causes of death were: hernia in 30 cases (57.7%), septic shock in 10 cases (19.2%), systemic failure in 3 cases (5.77%) and gastrointestinal bleeding in 3 cases (5.77%). (5) There were 78 cases in 126 cases ≤ 14 years old, 12 cases of BCG vaccination, 48 cases of migrant children and 3 cases of BCG vaccination. Conclusion Increasing the detection rate of Mycobacterium tuberculosis is very important for improving the diagnosis of TBM. MRI examination is of great significance for the diagnosis of TBM. The treatment of hernia, effective anti-infection, nutritional support, prevention and treatment of gastrointestinal bleeding are the success or failure of TBM treatment The key; need to pay attention to BCG vaccination and vaccination quality.