全身炎症反应可预测结核性脑膜炎患者的神经功能转归：一项中国多中心回顾性队列研究

Systemic Inflammation Predict Neurological Functional Outcome in Patients with Tuberculous Meningitis: A Multicenter Retrospective Cohort Study in China.

作者信息

Guo Yijia, Zhang Ruyun, Gan Xinling, Wang Erli, Lu Shuihua, Jiang Hui, Duan Hongfei, Yuan Zhengzhou, Li Weimin, Liu Yong

机构信息

Department of Neurology, Chengdu Medical College, The First Affiliated Hospital, Chengdu, People's Republic of China.

Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, People's Republic of China.

出版信息

J Inflamm Res. 2024 Oct 22;17:7561-7571. doi: 10.2147/JIR.S489495. eCollection 2024.

DOI:10.2147/JIR.S489495

PMID:39464341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11512555/

Abstract

BACKGROUND

The predictors associated with clinical outcomes in patients with tuberculous meningitis (TBM) remain unclear. We aimed to analyse the relationship between systemic inflammation and clinical outcomes, as well as to explore whether systemic inflammation level influences the effectiveness of dexamethasone on treatment.

METHODS

Between January 2011 and December 2021, TBM patients admitted to five hospitals were observed consecutively. Baseline and post-treatment systemic inflammation levels were calculated using the neutrophil-lymphocyte-ratio (NLR). Generalized linear mixed models were employed to identify predictors of clinical outcomes. Propensity score matching and subgroup analyses were conducted to evaluate the effect of dexamethasone on treatment outcomes across different NLR levels.

RESULTS

A total of 1203 TBM patients were included in the study. During the follow-up, 144 (13.6%) participants experienced early neurological deterioration within 7 days after admission, and 345 (28.67%) exhibited poor functional outcome at the 12-month follow-up. Multivariate analysis revealed that post-treatment NLR was significantly associated with early neurological deterioration (OR=1.25; 95% CI, 1.14-1.33; P<0.001), and poor outcome (OR=1.34; 95% CI, 1.26-1.45; P<0.001). After propensity score matching, dexamethasone treatment was not associated with early neurological deterioration (OR=0.83; 95% CI, 0.42-1.66; P=0.610) or poor outcome (OR=1.22; 95% CI, 0.49-2.11; P=0.490) in the highest quartile of post-treatment NLR. The effect of dexamethasone on treatment outcomes did not significantly vary with disease severity stratification.

CONCLUSION

Elevated systemic inflammation is an independent risk factor for neurological outcome in TBM patients. Further studies are required to investigate systemic inflammation in more severely affected population to better predict the outcomes following anti-inflammatory therapies.

摘要

背景

结核性脑膜炎（TBM）患者临床结局的相关预测因素尚不清楚。我们旨在分析全身炎症与临床结局之间的关系，并探讨全身炎症水平是否会影响地塞米松的治疗效果。

方法

2011年1月至2021年12月期间，对五家医院收治的TBM患者进行连续观察。使用中性粒细胞与淋巴细胞比值（NLR）计算基线和治疗后的全身炎症水平。采用广义线性混合模型确定临床结局的预测因素。进行倾向得分匹配和亚组分析，以评估地塞米松在不同NLR水平下对治疗结局的影响。

结果

本研究共纳入1203例TBM患者。随访期间，144例（13.6%）参与者在入院后7天内出现早期神经功能恶化，345例（28.67%）在12个月随访时功能结局不佳。多因素分析显示，治疗后NLR与早期神经功能恶化显著相关（比值比[OR]=1.25；95%置信区间[CI]，1.14-1.33；P<0.001），与不良结局也显著相关（OR=1.34；95%CI，1.26-1.45；P<0.001）。倾向得分匹配后，在地塞米松治疗组中，治疗后NLR处于最高四分位数的患者，其早期神经功能恶化（OR=0.83；95%CI，0.42-1.66；P=0.610）或不良结局（OR=1.22；95%CI，0.49-2.11；P=0.490）与地塞米松治疗无相关性。地塞米松对治疗结局的影响在不同疾病严重程度分层中无显著差异。