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目的评价小儿结核性脑膜炎(TBM)的临床、实验室和影像学特征,为诊断和判定TBM预后提供科学依据。方法收集55例诊断为TBM患儿的年龄、性别、结核病史、入院前症状持续时间(>5 d)、临床症状、临床分期、实验室检测数据、胸部X线片、头颅CT或MRI改变及预后等临床资料进行回顾性分析。结果 55例患儿年龄1.5~12.0岁,平均年龄(5.32±2.98)岁,<6岁38例(69.09%)。临床特点:有结核病史33例(60.00%);TBM临床表现分期为Ⅱ或Ⅲ期46例(83.64%),入院前症状持续时间(DSBA)>5 d 47例(85.45%)。除死亡8例(14.54%)外,余均给予至少6个月的抗结核治疗。评价疗效:正常8例(14.54%)、轻微后遗症23例(41.82%)和严重后遗症16例(29.09%)。单因素分析:结核病史、精神症状、抽搐、年龄、局部神经功能障碍、临床表现分期为Ⅱ和Ⅲ期、头颅CT和MRI改变是预后不良的相关影响因素。多因素Logistic回归分析表明:临床表现分期为Ⅲ期,头颅CT和MRI有改变的患儿预后较差。结论 TBM患儿临床症状特异性差,确诊时已合并脑损伤,尤其是临床分期晚、颅内有病变的患儿预后较差,早期诊断和治疗可显著改善预后。
Objective To evaluate the clinical, laboratory and imaging features of children with tuberculous meningitis (TBM) and provide a scientific basis for the diagnosis and prognosis of TBM. Methods The age, gender, history of tuberculosis, the duration of pre-admission symptoms (> 5 d), clinical symptoms, clinical stage, laboratory test data, chest X-ray, CT or MRI changes of 55 children with TBM and Prognosis and other clinical data for retrospective analysis. Results 55 cases of children aged 1.5 to 12.0 years, mean age (5.32 ± 2.98) years old, <6 years old 38 cases (69.09%). Clinical features: There were 33 cases (60.00%) with TB history; 46 cases (83.64%) had TBM clinical stage Ⅱ or stage Ⅲ, 47 cases (85.45%) had DSBA> 5 days before admission. In addition to the death of 8 cases (14.54%), the remaining were given at least 6 months of anti-TB treatment. Evaluation of efficacy: normal in 8 cases (14.54%), minor sequelae in 23 cases (41.82%) and severe sequelae in 16 cases (29.09%). Univariate analysis: history of tuberculosis, psychiatric symptoms, convulsions, age, local neurological dysfunction, clinical manifestations stage Ⅱ and Ⅲ, head CT and MRI changes are related to poor prognosis factors. Multivariate logistic regression analysis showed that the stage of clinical manifestations was stage III, and the prognosis of children with changes of head CT and MRI was poor. Conclusions Children with TBM have poor clinical symptoms and have been diagnosed with brain injury. Especially in children with clinical stage and intracranial lesions, the prognosis is poor. Early diagnosis and treatment can significantly improve the prognosis.