Yang Z R, Zhang L F, Zhou B T, Shi X C, Cao W, Fan H W, Liu Z Y, Li T S, Liu X Q
State Key Laboratory of Complex Severe and Rare Diseases, Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
State Key Laboratory of Complex Severe and Rare Diseases, Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China Centre for Tuberculosis Research, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2022 Jul 1;61(7):764-770. doi: 10.3760/cma.j.cn112138-20220121-00069.
To investigate the clinical features and influencing factors of long-term prognosis of tuberculous meningitis(TBM), and to provide a recommendation for treatment and early intervention of TBM. Clinical data of TBM patients were retrospectively collected at Peking Union Medical College Hospital from January 2014 to December 2021. Patients who were followed-up more than one year were divided into two groups according to modified Rankin Scale (mRS). Risk factors associated with long-term prognosis were analyze by conditional logistic stepwise regression. A total of 60 subjects were enrolled including 33 (55%) males and 27 (45%) females with age 15-79 (44.5±19.8) years. There were 30 cases (50%) complicated with encephalitis, 21 cases (35%) with miliary tuberculosis. The diagnosis was microbiologically confirmed in 22 patients (36.7%), including 5 cases (22.7%, 5/22) by acid-fast staining, 8 cases (36.4%, 8/22) by (MTB) culture, and 20 cases (90.9%, 20/22) by molecular biology. The median follow-up period was 52(43, 66 ) months in 55 cases surviving more than one year. Among them, 40 cases (72.7%) were in favorable group (mRS 0-2) and 15 cases (27.3%) were in unfavorable group (mRS 3-6) with poor prognosis. The mortality rate was 20% (11/55). Elderly (=1.06, =0.048 ) , hyponatremia(=0.81,=0.020), high protein level in cerebrospinal fluid (CSF) (=3.32,=0.033), cerebral infarction(=10.50,=0.040) and hydrocephalus(=8.51,=0.049) were associated with poor prognosis in TBM patients. The mortality rate is high in patients with TBM. Molecular biology tests improves the sensitivity and shorten the diagnosis time of TBM. Elderly, hyponatremia, high protein level in CSF, cerebral infarction and hydrocephalus are independent risk factors of long-term survival in TBM patients.
探讨结核性脑膜炎（TBM）长期预后的临床特征及影响因素，为TBM的治疗及早期干预提供建议。回顾性收集2014年1月至2021年12月在北京协和医院就诊的TBM患者的临床资料。对随访时间超过1年的患者，根据改良Rankin量表（mRS）分为两组。采用条件logistic逐步回归分析与长期预后相关的危险因素。共纳入60例患者，其中男性33例（55%），女性27例（45%），年龄15 - 79岁（44.5±19.8）岁。30例（50%）合并脑炎，21例（35%）合并粟粒性肺结核。22例（36.7%）患者经微生物学确诊，其中5例（22.7%，5/22）通过抗酸染色确诊，8例（36.4%，8/22）通过结核分枝杆菌（MTB）培养确诊，20例（90.9%，20/22）通过分子生物学确诊。55例存活超过1年的患者中位随访时间为52（43，66）个月。其中，40例（72.7%）为预后良好组（mRS 0 - 2），15例（27.3%）为预后不良组（mRS 3 - 6）。死亡率为20%（11/55）。年龄较大（=1.06，=0.048）、低钠血症（=0.81，=0.020）、脑脊液（CSF）蛋白水平升高（=3.32，=0.033）、脑梗死（=10.50，=0.040）和脑积水（=8.51，=0.049）与TBM患者预后不良相关。TBM患者死亡率较高。分子生物学检测提高了TBM的诊断敏感性并缩短了诊断时间。年龄较大、低钠血症、CSF蛋白水平升高、脑梗死和脑积水是TBM患者长期生存的独立危险因素。
