【摘要】 目的总结彝族地区小儿结核性脑膜炎的临床特征,探讨早期诊断的有效方法,减少误诊。方法回顾性分析2010年01月至2012年12月我院71例临床诊断结核性脑膜炎的住院患儿病例资料。结果①各年龄组均有发病,以7~14岁组最多,男女比例为2.381。彝族患病率为1.56%,汉族患病率为0.1%。农村儿童患病率为0.77%,城镇儿童患病率为0.29%,彝族与汉族比较,农村与城镇儿童比较差异均有统计学意义(P<0.01)。②本组患儿卡介苗接种率、阳性接触史和PPD阳性率均较低,分别为5.6%,8.5%,和36%。③本组患儿中中晚期病例占85.9%。最常见的临床表现为发热,占94.4%。早期几乎所有患儿均有不同程度的性格改变,而颅内高压、抽搐、意识障碍则是突出的临床症状。④71例患儿中脑脊液检查90.1%有细胞数增高,而糖降低50%以上者占41.5%。46.9%胸片或胸部CT检查异常,其中6例为粟粒性肺结核。60.8%(42/69)头部CT检查异常。其中33例表现为脑积水占表现异常者的47.8%(33/69)。结论①彝族、农村儿童结脑患病率高于汉族、城镇儿童患病率。②彝族地区卡介苗接种覆盖率低,发病率高,应重视宣传及加强对基层的防御工作。③性格改变是结脑早期最普遍的临床特点,应高度重视。④发热伴颅内压增高,脑神经损害是小儿结核性脑膜炎常见的表现。⑤头颅CT是结核性脑膜炎早期诊断和判断预后比较有效的方法。肺结核的血行转移仍是结核性脑膜炎的重要原因之一,对疑诊患儿或脑脊液不典型患儿应早期行头部CT及胸片检查。更多还原

【Abstract】 Objective To investigate the clinical features of pediatric tuberculous meningitis in Yi ethnic area are to discuss the effective methods of early diagnosis and reduction of misdiagnosis. Method A retrospective analysis was carried out for the medical records of 71 children clinically diagnosed as tuberculous meningitis in our hospital from January 2010 to December 2012. Results ①The disease was detected in different age groups,notably for children aged 7 ~ 14 years. the ratio of male to female was2. 38: 1. The incidence in Yi ethnic group was 1. 56%,while that in Han ethnic group was 0. 1%. The incidence of rural children was 0. 77%,while that of urban children was 0. 29%. It was indicated by the comparisons between Yi ethnic group and Han ethnic group and between rural and urban children that there was great significance for the differences( P<0. 01). ②The Bacillus Calmette-Guerin( BCG) vaccination rate,positive contact history and positive PPD rate of pediatric patients were all low in this group,with the value being 5. 6%,8. 5% and 36%,respectively. ③The cases of mid and advanced stage accounted for 85. 9%( 61/71). The most common clinical manifestation is fever,which accounted for 94.4%( 67/71). Nearly all pediatric patients showed personality changes with various degrees in early period. Intracranial hypertension,convulsion and conscious disturbance are the most prominent clinical manifestations. ④Of 71 pediatric patients subjected to cerebrospinal fluid examination,90. 1%( 64/71) showed the increase of cell count. The patients with glucose decrease by over 50% accounted for 41.5%( 22/71).46. 9%( 31 /66) of patients were found abnormal by chest X-ray or chest CT. Six cases( 19. 4%) were diagnosed as miliary tuberculosis; 60. 8% of patients( 42 /69) were found abnormal by cranial CT. Among them,33 cases showed hydrocephalus,accounting for 47. 8%( 33 /69) of the abnormal cases. Conclusion ①The incidence of tuberculous meningitis of rural children in Yi ethnic group was higher than that of urban children in Han ethnic group. ②The BCG vaccination rate has a low coverage in Yi ethnic area,which results in a high incidence. Therefore,the health education and prevention measures should be enhanced at the grass-root level. ③The personality change is the most common clinical feature of tuberculous meningitis in the early stage,and deserves high attention. ④The intracranial pressure increased accompanies with fever. The cranial nerve damage is the common manifestation of pediatric tuberculous meningitis. ⑤Cranial CT is an effective method for the early diagnosis and prognostic prediction of tuberculous meningitis. The hematogenous metastasis of pulmonary tuberculosis is one of the important causes of tuberculous meningitis. The suspected cases or patients with atypical cerebrospinal fluid should receive cranial CT and chest X-ray exam.更多还原