van Well Gijs T J, Paes Berbe F, Terwee Caroline B, Springer Priscilla, Roord John J, Donald Peter R, van Furth A Marceline, Schoeman Johan F
Departments of Pediatrics and Infectious Diseases, VU University Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands.
Pediatrics. 2009;123(1):e1-8. doi: 10.1542/peds.2008-1353.
Tuberculous meningitis is the most severe extrapulmonary complication of tuberculosis, with high morbidity and mortality rates. The objective of this study was to assess the relationship between presenting clinical characteristics and outcome of pediatric tuberculous meningitis.
We present a retrospective cohort study of all of the children diagnosed with tuberculous meningitis in a large university hospital in South Africa between January 1985 and April 2005. We compared demographic, clinical, and diagnostic characteristics with clinical outcome after 6 months of treatment.
We included 554 patients. Common characteristics on admission were young age (82%; <5 years), stage II or III tuberculous meningitis (97%), nonspecific symptoms existing for >1 week (58%), poor weight gain or weight loss (91%), loss of consciousness (96%), motor deficit (63%), meningeal irritation (98%), raised intracranial pressure (23%), brainstem dysfunction (39%), and cranial nerve palsies(27%). Common features of tuberculous meningitis on computed tomography scan of the brain were hydrocephalus (82%), periventricular lucency (57%), infarctions(32%), and basal meningeal enhancement (75%). Clinical outcome after 6 months was as follows: normal (16%), mild sequelae (52%), severe sequelae (19%), and death (13%). All of the patients diagnosed with stage I tuberculous meningitis had normal outcome. Factors associated with poor outcome in univariate analyses were as follows: African ethnicity, young age, HIV coinfection, stage III tuberculous meningitis, absence of headache and vomiting, convulsions, decreased level of consciousness,motor deficits, cranial nerve palsies, raised intracranial pressure, brain stem dysfunction and radiographic evidence of hydrocephalus, periventricular lucency, and infarction. Ethnicity, stage of disease, headache, convulsions, motor function, brainstem dysfunction, and cerebral infarctions were independently associated with poor outcome in multivariate logistic regression analysis.
Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Earlier diagnosis will improve outcome significantly. We were able to identify presenting variables independently associated with poor clinical outcome.
结核性脑膜炎是结核病最严重的肺外并发症，发病率和死亡率都很高。本研究的目的是评估儿童结核性脑膜炎的临床表现与预后之间的关系。
我们对1985年1月至2005年4月间在南非一家大型大学医院确诊为结核性脑膜炎的所有儿童进行了一项回顾性队列研究。我们将人口统计学、临床和诊断特征与治疗6个月后的临床结局进行了比较。
我们纳入了554例患者。入院时的常见特征包括年龄小（82%；<5岁）、II期或III期结核性脑膜炎（97%）、非特异性症状持续>1周（58%）、体重增加不佳或体重减轻（91%）、意识丧失（96%）、运动功能障碍（63%）、脑膜刺激征（98%）、颅内压升高（23%）、脑干功能障碍（39%）和脑神经麻痹（27%）。脑部计算机断层扫描显示结核性脑膜炎的常见特征为脑积水（82%）、脑室周围透亮区（57%）、梗死（32%）和基底脑膜强化（75%）。6个月后的临床结局如下：正常（16%）、轻度后遗症（52%）、重度后遗症（19%）和死亡（13%）。所有诊断为I期结核性脑膜炎的患者结局均正常。单因素分析中与不良结局相关的因素如下：非洲种族、年龄小、合并HIV感染、III期结核性脑膜炎、无头痛和呕吐、惊厥、意识水平下降、运动功能障碍、脑神经麻痹、颅内压升高、脑干功能障碍以及脑积水、脑室周围透亮区和梗死的影像学证据。在多因素逻辑回归分析中，种族、疾病分期、头痛、惊厥、运动功能、脑干功能障碍和脑梗死与不良结局独立相关。
结核性脑膜炎起病时症状不具特异性，往往在脑损伤已经发生时才得以诊断。早期诊断将显著改善预后。我们能够识别出与不良临床结局独立相关的呈现变量。
