Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India.
Am J Trop Med Hyg. 2024 Jun 25;111(2):251-258. doi: 10.4269/ajtmh.23-0312. Print 2024 Aug 7.
In tuberculous meningitis (TBM), the meningeal symptoms and their resolution after treatment may be dependent on clinical-radiological severity, cerebrospinal fluid (CSF), and proinflammatory cytokines, and these findings may be associated with outcome. There is a paucity of studies on the resolution of meningitis symptoms in TBM. We report on associations of clinical, magnetic resonance imaging (MRI), laboratory, and proinflammatory cytokines [tumor necrosis factor (TNF)-α and interleukin 6 (IL-6)] findings with the resolution of meningitis symptoms (RMS), and the impact of RMS duration on the outcome in TBM. Seventy-one patients with TBM were included, and their clinical, laboratory, and MRI findings at baseline were recorded. mRNA profiling of TNF-α and IL-6 was done by reverse transcriptase polymerase chain reaction. The day of RMS (fever, headache, and vomiting) after treatment was noted. Predictors of long duration of RMS (>3 weeks) were evaluated by univariate followed by multivariate analysis. The impact of RMS on 6-month mortality and outcome was analyzed. Patients' median age was 25 years, and 45 (63.4%) were males. After antitubercular treatment, meningeal symptoms resolved in 35 (50.70%) by 21 days and in 90% of patients by 49 days. Longer time of RMS was associated with TBM stage, pretreatment duration, seizure, and hydrocephalus but not with TNF-α and IL-6. Seven (9.8%) patients died at 6 months, and duration of RMS predicted death (hazard ratio = 25.55, 95% CI: 1.108-589.40; P = 0.04).
在结核性脑膜炎（TBM）中，脑膜症状及其治疗后的缓解情况可能取决于临床-影像学严重程度、脑脊液（CSF）和促炎细胞因子，这些发现可能与结局相关。关于 TBM 中脑膜炎症状缓解的研究很少。我们报告了 TBM 中脑膜症状缓解（RMS）与临床、磁共振成像（MRI）、实验室和促炎细胞因子[肿瘤坏死因子（TNF）-α和白细胞介素 6（IL-6）]发现之间的关联，以及 RMS 持续时间对 TBM 结局的影响。纳入了 71 例 TBM 患者，并记录了他们的基线临床、实验室和 MRI 发现。通过逆转录聚合酶链反应进行 TNF-α 和 IL-6 的 mRNA 谱分析。注意治疗后 RMS（发热、头痛和呕吐）的出现日期。通过单变量和多变量分析评估 RMS 持续时间较长（>3 周）的预测因素。分析 RMS 对 6 个月死亡率和结局的影响。患者的中位年龄为 25 岁，45 例（63.4%）为男性。抗结核治疗后，35 例（50.70%）患者在 21 天内，90%的患者在 49 天内缓解脑膜症状。RMS 持续时间较长与 TBM 分期、治疗前持续时间、癫痫发作和脑积水有关，但与 TNF-α 和 IL-6 无关。7 例（9.8%）患者在 6 个月时死亡，RMS 持续时间预测死亡（危险比=25.55，95%CI：1.108-589.40；P=0.04）。
