Huang Hai-Jun, Ren Ze-Ze, Dai Yi-Ning, Tong Yong-Xi, Yang Dan-Hong, Chen Mei-Juan, Huang Yi-Cheng, Wang Ming-Shan, Zhang Jia-Jie, Song Wen-Yuan, Pan Hong-Ying
Department of Infectious Diseases, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College Department of Infectious Diseases, the Second Affiliated Hospital of Zhejiang Chinese Medicinal University, Hangzhou, Zhejiang Province, China.
Medicine (Baltimore). 2017 Jun;96(26):e7370. doi: 10.1097/MD.0000000000007370.
Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis with a very poor prognosis. We aimed at assessing risk factors related to the prognosis of patients with TBM.Forty-five inpatients with TBM in our institution from January 2013 to December 2015 were enrolled retrospectively. The good or poor prognosis in the patients was defined, based on Glasgow Outcome Scale System at discharge. Patients with a GOS score less than 5 were defined as "poor prognosis." Univariate and multivariate logistic regression analyses were performed to assess the predictors for TBM outcome.Among 45 TBM patients, 35 (77.8%) and 10 (22.2%) were in good, poor prognoses, respectively. Old age, disturbance of consciousness, moderate to severe electroencephalogram abnormality, hydrocephalus, remarkable increase of protein (≥ 236 mg/dL) and white blood cell counts (≥ 243 /μL) in cerebral spinal fluid were associated with poor prognosis. Multivariate analysis indicated that old age (odds ratio (OR) = 18.395, P = .036) and hydrocephalus (OR = 32.995, P = .049) were independent factors for a poor outcome of TBM.In conclusion, old age and hydrocephalus are the predictors for poor prognosis of TBM. Patients with these risk factors should be treated promptly with a special care paid to improve their outcomes.
结核性脑膜炎（TBM）是中枢神经系统结核最常见的形式，预后很差。我们旨在评估与TBM患者预后相关的危险因素。回顾性纳入了2013年1月至2015年12月在我院住院的45例TBM患者。根据出院时的格拉斯哥预后量表系统定义患者预后良好或不良。格拉斯哥预后量表（GOS）评分小于5分的患者被定义为“预后不良”。进行单因素和多因素逻辑回归分析以评估TBM预后的预测因素。在45例TBM患者中，预后良好和不良的分别有35例（77.8%）和10例（22.2%）。老年、意识障碍、中度至重度脑电图异常、脑积水、脑脊液中蛋白显著升高（≥236mg/dL）和白细胞计数显著升高（≥243/μL）与预后不良相关。多因素分析表明，老年（比值比（OR）=18.395，P=0.036）和脑积水（OR=32.995，P=0.049）是TBM预后不良的独立因素。总之，老年和脑积水是TBM预后不良的预测因素。有这些危险因素的患者应及时治疗，并特别注意改善其预后。
