中国结核性脑膜炎患者的治疗总延迟：一项回顾性队列研究。
Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study.
作者信息
He Yu, Han Chao, Chang Kai-Feng, Wang Mao-Shui, Huang Tian-Ren
机构信息
Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Epidemiology, Affiliated Tumor Hospital of Guangxi Medical University, 71#, Hedi Road, Nanning, 530021, China.
出版信息
BMC Infect Dis. 2017 May 12;17(1):341. doi: 10.1186/s12879-017-2447-0.
BACKGROUND
Currently, there is limited data on the risk factors associated with treatment delay in tuberculous meningitis (TBM). This study aimed to assess the duration of delay in the treatment TBM and to investigate its determinants.
METHODS
During the period from September 2009 to February 2016, a retrospective cohort study of consecutive TBM patients admitted to our hospital was conducted to determine the risk factors associated with treatment delay in TBM. Treatment delay duration was defined as the time interval from onset of symptoms (by patient recall) to initiation of treatment and was stratified into two categories: ≤ 20 days, >20 days (median delay day is 20 days). Data collected included demography, comorbidity, cerebrospinal fluid (CSF) examinations and others. Univariable and multivariable logistic regression analysis was used to evaluate the determinants of treatment delay.
RESULTS
A total of 161 TBM patients were included in our study, all were confirmed by CSF mycobacterial culture. The median treatment delay for all patients included in the study was 20 days [interquartile range, 14-60 days]. Multivariate analysis revealed that age (≤21 years old, OR = 0.202, 95% CI: 0.079, 0.521), fever (OR = 0.414, 95% CI: 0.180, 0.952), and headache (OR = 0.204, 95% CI: 0.095, 0.442) had significantly lower risk for treatment delay, while multiple healthcare contact (>3 times) (OR = 3.938, 95% CI: 1.326, 11.691) as well as CSF chloride (>111 mmol/L) (OR = 2.479, 95% CI: 1.143, 5.377) had significantly higher risk of the delay.
CONCLUSIONS
Our findings indicate that multiple healthcare contact and high CSF chloride predict the risk of long delay, while young age, fever and headache are associated with short delay. Maintained focus on awareness of TBM in the population and in healthcare systems, and continuous implementation of diagnostic methods for TBM to detect the disease early, may reduce the mortality and morbidity.
背景
目前，关于结核性脑膜炎（TBM）治疗延迟相关危险因素的数据有限。本研究旨在评估TBM治疗延迟的时长，并探究其决定因素。
方法
在2009年9月至2016年2月期间，对我院收治的连续性TBM患者进行回顾性队列研究，以确定TBM治疗延迟的相关危险因素。治疗延迟时长定义为从症状出现（根据患者回忆）到开始治疗的时间间隔，并分为两类：≤20天，>20天（中位延迟天数为20天）。收集的数据包括人口统计学、合并症、脑脊液（CSF）检查等。采用单变量和多变量逻辑回归分析来评估治疗延迟的决定因素。
结果
本研究共纳入161例TBM患者，均经CSF分枝杆菌培养确诊。纳入研究的所有患者的中位治疗延迟时间为20天[四分位间距，14 - 60天]。多变量分析显示，年龄（≤21岁，OR = 0.202，95%CI：0.079，0.521）、发热（OR = 0.414，95%CI：0.180，0.952）和头痛（OR = 0.204，95%CI：0.095，0.442）的治疗延迟风险显著较低，而多次就医（>3次）（OR = 3.938，95%CI：1.326，11.691）以及CSF氯化物（>111 mmol/L）（OR = 2.479，95%CI：1.143，5.377）的延迟风险显著较高。
结论
我们的研究结果表明，多次就医和高CSF氯化物预示着长期延迟的风险，而年轻、发热和头痛与短期延迟相关。持续关注人群和医疗系统中对TBM的认识，并持续采用TBM诊断方法以早期发现疾病，可能会降低死亡率和发病率。
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