【摘要】 目的探讨结核性脑膜炎(tuberculous meningitis, TBM)患者近期预后的危险因素。方法本研究设计为回顾性分析,共计纳入TBM患者310例,以患者出院时的疾病状态(好转或死亡)为作为近期预后的评价指标,并收集患者的一般临床资料、实验室检查、神经影像学检查等因素进行单因素和二分类多因素Logistic回归分析,分析出TBM患者近期预后的危险因素。结果病死组入院时存在意识障碍、克氏征阳性和锥体束征阳性的发生率均高于疾病好转组(P<0.05)。病死组入院时外周血白细胞计数高于疾病好转组,外周血淋巴细胞百分比显著低于疾病好转组(P<0.05)。病死组的脑脊液颜色有色(淡黄色、黄色或浑浊)的发生率高于疾病好转组(P<0.05)。病死组的脑积水阳性患者发生率高于疾病好转组,脑结核瘤阳性发生率低于疾病好转组(P<0.05)。多因素分析结果提示入院时的外周血白细胞计数、外周血淋巴细胞百分比以及血糖为影响TBM患者近期预后的独立危险因素(P<0.05)。结论入院时外周血白细胞计数升高、外周血淋巴细胞百分比降低以及血糖升高的TBM患者的临床近期预后相对较差。更多还原

【Abstract】 Objective To investigate the short-term prognostic risk factors for patients with tuberculous meningitis(TBM). Methods Designed as a retrospective study, this study included a total of 310 patients with TBM. The outcome indicators for short-term prognosis were defined as the disease status(improvement or death) when the patients were discharged from the hospital. Additionally, the univariate and multivariate binary Logistic regression analyses were performed including the baseline characteristics, laboratory examination, neuroimaging examination and other factors to identify the risk factors that might contribute to the short-term prognostic risk factors for patients with TBM. Results The incidence of consciousness disturbance, positive Kremer′s sign and positive pyramidal tract sign were higher in death group than those in disease improvement group(P<0.05). The white blood cell(WBC) count of peripheral blood in death group was higher than that in disease improvement group, and the percentage of peripheral blood lymphocytes was significantly lower than that in the disease improvement group(P<0.05). The incidence of color(light yellow, yellow or cloudy) of cerebrospinal fluid in death group was higher than that in disease improvement group(P<0.05). And the incidence of positive hydrocephalus in death group was higher than that in disease improvement group, and the incidence of positive cerebral tuberculoma was lower than that in disease improvement group(P<0.05). Results of multivariate analysis suggested that the WBC counts, percentage of peripheral blood lymphocytes and blood glucose at admission were independent risk factors for the short-term prognosis of patients with TBM(P<0.05). Conclusion Elevated WBC counts, decreased percentage of peripheral blood lymphocytes and elevated blood glucose at admission TBM patients are associated with relatively worse short-term prognosis.更多还原