Wang Ting, Li Meng-Yan, Cai Xin-Shan, Cheng Qiu-Sheng, Li Ze, Liu Ting-Ting, Zhou Lin-Fu, Wang Hong-Hao, Feng Guo-Dong, Marais Ben J, Zhao Gang
Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou, China.
Front Microbiol. 2024 May 17;15:1374458. doi: 10.3389/fmicb.2024.1374458. eCollection 2024.
Tuberculous meningitis (TBM) is the most severe form of tuberculosis (TB) and can be difficult to diagnose and treat. We aimed to describe the clinical presentation, diagnosis, disease spectrum, outcome, and prognostic factors of patients treated for TBM in China.
A multicenter retrospective study was conducted from 2009 to 2019 enrolling all presumptive TBM patients referred to Xijing tertiary Hospital from 27 referral centers in and around Shaanxi province, China. Patients with clinical features suggestive of TBM (abnormal CSF parameters) were included in the study if they had adequate baseline information to be classified as "confirmed," "probable," or "possible" TBM according to international consensus TBM criteria and remained in follow-up. Patients with a confirmed alternative diagnosis or severe immune compromise were excluded. Clinical presentation, central nervous system imaging, cerebrospinal fluid (CSF) results, TBM score, and outcome-assessed using the modified Barthel disability index-were recorded and compared.
A total of 341 presumptive TBM patients met selection criteria; 63 confirmed TBM (25 culture positive, 42 Xpert-MTB/RIF positive), 66 probable TBM, 163 possible TBM, and 49 "not TBM." Death was associated with BMRC grade III (OR = 5.172; 95%CI: 2.298-11.641), TBM score ≥ 15 (OR = 3.843; 95%CI: 1.372-10.761), age > 60 years (OR = 3.566; 95%CI: 1.022-12.442), and CSF neutrophil ratio ≥ 25% (OR = 2.298; 95%CI: 1.027-5.139). Among those with confirmed TBM, nearly one-third (17/63, 27.0%) had a TBM score < 12; these patients exhibited less classic meningitis symptoms and signs and had better outcomes compared with those with a TBM score ≥ 12. In this group, signs of disseminated/miliary TB (OR = 12.427; 95%CI: 1.138-135.758) and a higher TBM score (≥15, OR = 8.437; 95%CI: 1.328-53.585) were most strongly associated with death.
TBM patients who are older (>60 years) have higher TBM scores or CSF neutrophil ratios, have signs of disseminated/miliary TB, and are at greatest risk of death. In general, more effort needs to be done to improve early diagnosis and treatment outcome in TBM patients.
结核性脑膜炎（TBM）是结核病（TB）最严重的形式，诊断和治疗可能具有挑战性。我们旨在描述在中国接受TBM治疗的患者的临床表现、诊断、疾病谱、结局及预后因素。
2009年至2019年进行了一项多中心回顾性研究，纳入中国陕西省及周边地区27个转诊中心转诊至西京三级医院的所有疑似TBM患者。具有TBM临床特征（脑脊液参数异常）且有足够基线信息，可根据国际共识TBM标准分类为“确诊”“很可能”或“可能”TBM并仍在随访中的患者纳入研究。排除确诊有其他诊断或严重免疫功能低下的患者。记录并比较临床表现、中枢神经系统影像学、脑脊液（CSF）结果、TBM评分及使用改良巴氏指数评估的结局。
共有341例疑似TBM患者符合入选标准；63例确诊TBM（25例培养阳性，42例Xpert-MTB/RIF阳性），66例很可能TBM，163例可能TBM，49例“非TBM”。死亡与英国医学研究委员会（BMRC）分级III级（OR = 5.172；95%CI：2.298 - 11.641）、TBM评分≥15（OR = 3.843；95%CI：1.372 - 10.761）、年龄>60岁（OR = 3.566；95%CI：1.022 - 12.442）及脑脊液中性粒细胞比例≥25%（OR = 2.298；95%CI：1.027 - 5.139）相关。在确诊TBM患者中，近三分之一（17/63，27.0%）的TBM评分为<12；与TBM评分≥12的患者相比，这些患者的典型脑膜炎症状和体征较少，结局较好。在该组中，播散性/粟粒性结核的体征（OR = 12.427；95%CI：1.138 - 135.758）和较高的TBM评分（≥15，OR = 8.437；95%CI：1.328 - 53.585）与死亡关联最为密切。
年龄较大（>60岁）、TBM评分较高或脑脊液中性粒细胞比例较高、有播散性/粟粒性结核体征的TBM患者死亡风险最高。总体而言，需要付出更多努力来改善TBM患者的早期诊断和治疗结局。
