Schoeman J F, Van Zyl L E, Laubscher J A, Donald P R
Department of Paediatrics and Child Health, Faculty of Medicine, University of Stellenbosch, Tygerberg, Republic of South Africa.
Pediatrics. 1997 Feb;99(2):226-31. doi: 10.1542/peds.99.2.226.
To study the effect of highdose prednisone on intracranial pressure (ICP), cranial computed tomographic (CT) findings, and clinical outcome in young children with moderate to severe tuberculous meningitis (TBM).
Prospective, controlled, randomized study.
Continuous lumbar, cerebrospinal fluid pressure monitoring and contrasted CT scanning were performed in 141 consecutive children with TBM at admission. All children were then randomly allocated to a nonsteroid group (71 children) or a steroid group (70 children) who received prednisone (first 16 children, 2 mg/kg per day; next 54 children, 4 mg/kg per day) for the first month of treatment. ICP monitoring and CT scanning were repeated regularly, and clinical outcome was assessed after 6 months of antituberculosis treatment.
No statistically significant difference in ICP or the degree of hydrocephalus (as demonstrated by CT scan) was found between the steroid and nonsteroid groups after the first month of treatment. Basal ganglia infarcts developed in 16% of children in the steroid group and 24% in the nonsteroid group during the first month of treatment. Neither this incidence nor the eventual size of infarcts present at admission differed significantly between the two treatment groups. Single or multiple tuberculomas were seen on the first CT scans of 7 children (5%), whereas tuberculomas developed in 11 children (8%) at treatment. Both the response of the tuberculomas to treatment and the incidence of new tuberculomas were significantly improved by steroid therapy. Basal enhancement was also significantly less in the steroid group after 1 month of treatment. Steroids lowered mortality in stage III TBM significantly. Similarly, more surviving children in the steroid group had IQs of greater than 75 than did the those in the nonsteroid group. No significant difference was found in the incidence of motor deficit, blindness, or deafness.
Corticosteroids significantly improved the survival rate and intellectual outcome of children with TBM. Enhanced resolution of the basal exudate and tuberculomas by steroids was shown by serial CT scanning. Corticosteroids did not affect ICP or the incidence of basal ganglia infarction significantly.
研究大剂量泼尼松对中度至重度结核性脑膜炎（TBM）患儿颅内压（ICP）、头颅计算机断层扫描（CT）表现及临床结局的影响。
前瞻性、对照、随机研究。
对141例连续入院的TBM患儿进行持续腰椎脑脊液压力监测和增强CT扫描。然后将所有患儿随机分为非类固醇组（71例患儿）或类固醇组（70例患儿），类固醇组在治疗的第一个月接受泼尼松治疗（最初16例患儿，每日2mg/kg；接下来54例患儿，每日4mg/kg）。定期重复ICP监测和CT扫描，并在抗结核治疗6个月后评估临床结局。
治疗第一个月后，类固醇组和非类固醇组在ICP或脑积水程度（CT扫描所示）方面无统计学显著差异。治疗第一个月期间，类固醇组16%的患儿出现基底节梗死，非类固醇组为24%。两个治疗组之间，这种梗死发生率及入院时梗死灶的最终大小均无显著差异。7例患儿（5%）的首次CT扫描显示有单个或多个结核瘤，而治疗时有11例患儿（8%）出现结核瘤。类固醇治疗显著改善了结核瘤对治疗的反应及新结核瘤的发生率。治疗1个月后，类固醇组的基底节强化也显著减轻。类固醇显著降低了III期TBM的死亡率。同样，类固醇组存活且智商高于75的患儿比非类固醇组更多。在运动障碍、失明或失聪的发生率方面未发现显著差异。
皮质类固醇显著提高了TBM患儿的生存率和智力结局。系列CT扫描显示，类固醇可增强基底节渗出物和结核瘤的消散。皮质类固醇对ICP或基底节梗死的发生率无显著影响。
