Lu C H, Chang W N, Chang H W
Dept. of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung Hsien, Taiwan.
Infection. 2001 Dec;29(6):299-304. doi: 10.1007/s15010-001-1100-3.
Our aim was to analyze the prognostic factors and therapeutic outcomes of adult tuberculous meningitis (TBM).
Clinical data of 36 patients with adult TBM were retrospectively identified at our institution over a period of 5 years.
36 adult TBM patients, 23 males and 13 females, aged 16-83 years, were included in this study. The 36 patients were also divided into three groups (stages I, II and III) according to the severity of TBM on admission. Therapeutic outcomes at 3 months were determined using a modified Barthel Index (BI). For the purpose of statistical analysis, the patients were divided into two groups: good outcome (BI > or = 12) and poor outcome (BI < 12). Positive cerebrospinal fluid (CSF) culture was found in 47% (17/36) of patients and isoniazid-resistant strains were found in 18% (3/17) of culture-proven TBM. We statistically compared clinical manifestations, CSF features and therapeutic results of the two patient groups. Significant prognostic factors included severity of TBM at the time of admission, the presence of headache, fever, hydrocephalus, high CSF protein concentration and high CSF lactate concentration. In stepwise logistic regression analysis, only the presence of hydrocephalus and severity of TBM on admission were strongly associated with therapeutic failure even after adjusting for other potentially confounding factors.
In Taiwan, TBM is an important public health issue and the emergence of resistant strains of this disease in recent years presents a therapeutic challenge. Because delay in diagnosis is directly related to poor outcome, early diagnosis and early treatment are essential for survival.
我们的目的是分析成人结核性脑膜炎（TBM）的预后因素及治疗结果。
回顾性分析我院5年间收治的36例成人TBM患者的临床资料。
本研究纳入36例成人TBM患者，其中男性23例，女性13例，年龄16 - 83岁。根据入院时TBM的严重程度将36例患者分为三组（Ⅰ期、Ⅱ期和Ⅲ期）。采用改良巴氏指数（BI）评估3个月时的治疗结果。为进行统计分析，将患者分为两组：良好预后（BI≥12）和不良预后（BI＜12）。47%（17/36）的患者脑脊液（CSF）培养呈阳性，在培养确诊的TBM患者中，18%（3/17）分离出耐异烟肼菌株。我们对两组患者的临床表现、CSF特征及治疗结果进行了统计学比较。显著的预后因素包括入院时TBM的严重程度、头痛、发热、脑积水、CSF蛋白浓度升高及CSF乳酸浓度升高。在逐步逻辑回归分析中，即使校正其他潜在混杂因素后，仅脑积水的存在及入院时TBM的严重程度与治疗失败密切相关。
在台湾，TBM是一个重要的公共卫生问题，近年来该疾病耐药菌株的出现带来了治疗挑战。由于诊断延迟直接与不良预后相关，早期诊断和早期治疗对生存至关重要。
