Department of Respiratory and Critical Care Medicine West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, China.
Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China.
BMC Pulm Med. 2019 Nov 6;19(1):200. doi: 10.1186/s12890-019-0966-8.
Tuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis. We sought to evaluate treatment outcomes for adult patients with this disease.
The Ovid MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched to identify all relevant studies. We pooled appropriate data to estimate treatment outcomes at the end of treatment and follow-up.
Among the articles identified, 22 met our inclusion criteria, with 2437 patients. In a pooled analysis, the risk of death was 24.7% (95%CI: 18.7-31.9). The risk of neurological sequelae among survivors was 50.9% (95%CI: 40.2-61.5). Patients diagnosed in stage III or human immunodeficiency virus (HIV) positive were significantly more likely to die (64.8, 53.4% respectively) during treatment. The frequency of cerebrospinal fluid (CSF) acid-fast-bacilli smear positivity was 10.0% (95% CI 5.5-17.6), 23.8% (15.2-35.3) for CSF culture positivity, and 22.3% (17.8-27.5) for CSF polymerase chain reaction positivity. We found that the headache, fever, vomiting, and abnormal chest radiograph were the most common symptoms and diagnostic findings among tuberculous meningitis patients.
Despite anti-tuberculosis treatment, adult tuberculous meningitis has very poor outcomes. The mortality rate of patients diagnosed in stage III or HIV co-infection increased significantly during treatment.
结核性脑膜炎是由结核分枝杆菌引起的最具破坏性的疾病表现。我们试图评估这种疾病的成年患者的治疗结果。
在 Ovid MEDLINE、EMBASE、Cochrane 图书馆和 Web of Science 数据库中搜索所有相关研究。我们汇总了适当的数据，以估计治疗结束时和随访时的治疗结果。
在所确定的文章中，有 22 篇符合纳入标准，共 2437 例患者。在汇总分析中，死亡风险为 24.7%（95%CI：18.7-31.9）。幸存者发生神经后遗症的风险为 50.9%（95%CI：40.2-61.5）。在治疗期间，诊断为 III 期或人类免疫缺陷病毒（HIV）阳性的患者死亡的可能性明显更高（分别为 64.8%和 53.4%）。脑脊液（CSF）抗酸杆菌涂片阳性的频率为 10.0%（95%CI 5.5-17.6），CSF 培养阳性的频率为 23.8%（15.2-35.3），CSF 聚合酶链反应阳性的频率为 22.3%（17.8-27.5）。我们发现头痛、发热、呕吐和异常胸部 X 线是结核性脑膜炎患者最常见的症状和诊断发现。
尽管进行了抗结核治疗，但成人结核性脑膜炎的预后仍很差。在治疗期间，诊断为 III 期或 HIV 合并感染的患者的死亡率显著增加。
