结核性脑膜炎的诊断标准及其验证
Diagnostic criteria for tuberculous meningitis and their validation.
作者信息
Ahuja G K, Mohan K K, Prasad K, Behari M
机构信息
Department of Neurology, All India Institute of Medical Sciences, New Delhi.
出版信息
Tuber Lung Dis. 1994 Apr;75(2):149-52. doi: 10.1016/0962-8479(94)90045-0.
SETTING
Tuberculous meningitis (TBM) has high morbidity and mortality. Demonstration of tubercle bacilli in cerebrospinal fluid (CSF), the only reliable method of diagnosis, is time consuming and has a low yield. Early diagnosis and treatment are of utmost importance for favourable outcome.
OBJECTIVE
The study was conceived to define easy to use criteria.
METHODS
A set of criteria using clinical features, CSF examination and computed tomography (CT) findings were defined. 76 patients suspected of having TBM were divided into definite, highly probable, probable and possible TBM based on the criteria. The validity of criteria was tested using information from bacterial isolation, polymerase chain reaction (PCR) test for tuberculosis, response to treatment and autopsy.
RESULTS
PCR was positive in over 75% of patients in the highly probable and probable groups. 91% of patients with highly probable and 66% with probable TBM improved on antituberculosis therapy.
CONCLUSION
The criteria are reliable in making early diagnosis of TBM.
背景
结核性脑膜炎（TBM）的发病率和死亡率都很高。脑脊液（CSF）中结核杆菌的检测是唯一可靠的诊断方法，但耗时且检出率低。早期诊断和治疗对于获得良好预后至关重要。
目的
本研究旨在确定易于使用的诊断标准。
方法
定义了一套基于临床特征、脑脊液检查和计算机断层扫描（CT）结果的标准。76例疑似TBM的患者根据这些标准被分为确诊、高度可能、可能和疑似TBM。利用细菌分离、结核聚合酶链反应（PCR）检测、治疗反应和尸检信息对标准的有效性进行了检验。
结果
高度可能组和可能组中超过75%的患者PCR呈阳性。高度可能的TBM患者中有91%、可能的TBM患者中有66%在抗结核治疗后病情改善。
结论
这些标准在TBM的早期诊断中是可靠的。
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