Schoeman J F, Elshof J W, Laubscher J A, Janse van Rensburg A, Donald P R
Tygerberg Children's Hospital, Faculty of Health Sciences, University of Stellenbosch, Cape Town, Republic of South Africa.
Ann Trop Paediatr. 2001 Dec;21(4):299-305. doi: 10.1080/07430170120093481.
Three recent studies found that corticosteroids improve clinical outcome and mortality in tuberculous meningitis (TBM), although the exact mechanism of action of the drug remains speculative. A number of reports on the effect of corticosteroids on cerebrospinal fluid (CSF) findings in TBM have been published, often with conflicting results regarding serial cell counts and protein levels. As part of a controlled, randomized trial on the effect of oral prednisone on outcome in childhood TBM at our institution, CSF was collected and analysed weekly during the 1st month of treatment. We found no significant difference in serial CSF cell counts between the steroid and non-steroid groups in the study. However, the steroid group had significantly lower CSF protein and globulin levels after the 1st month of treatment, and a more steady rise in CSF glucose levels than the non-steroid group. Knowledge of the different CSF responses during the course of anti-tuberculosis therapy is important in clinical decision-making.
最近的三项研究发现，皮质类固醇可改善结核性脑膜炎（TBM）的临床结局并降低死亡率，尽管该药物的确切作用机制仍具有推测性。关于皮质类固醇对TBM患者脑脊液（CSF）检查结果影响的许多报告已经发表，关于连续细胞计数和蛋白质水平的结果常常相互矛盾。作为我们机构一项关于口服泼尼松对儿童TBM结局影响的对照随机试验的一部分，在治疗的第1个月每周收集并分析CSF。我们发现研究中类固醇组和非类固醇组之间的连续CSF细胞计数没有显著差异。然而，治疗1个月后，类固醇组的CSF蛋白质和球蛋白水平显著降低，且CSF葡萄糖水平比非类固醇组上升得更稳定。了解抗结核治疗过程中不同的CSF反应对于临床决策很重要。
