【作者】 姚琳； 张建平； 王霞芳； 沈兴华； 叶志坚； 施美华； 吴妹英； 唐佩军；

【Author】 YAO Li;ZHANG Jian-ping;WANG Xia-fang;SHEN Xing-hua;YE Zhi-jian;SHI Mei-hua;WU Mei-ying;TANG Pei-jun;The Fifth People’s Hospital of Suzhou;

【机构】 江苏省苏州市第五人民医院；

【摘要】 目的 HIV阴性结核性脑膜炎(TBM)患者的临床特征及预后影响因素。方法回顾性分析2012年1月至2017年12月苏州市第五人民医院结核病科77例临床诊断为HIV阴性TBM患者的资料,并根据患者出院时改良Rankin量表(mRS)评分情况,将患者分为预后良好组(mRS评分:0～2分)和预后不良组(mRS评分:3～6分)。比较预后良好组和预后不良组患者临床特征的差异,并采用条件logistic逐步回归的方法分析影响患者预后的危险因素。结果 77例患者中,常见临床症状为头痛(68例,88.3%),发热(75例,97.4%),盗汗(69例,89.6%)。脑脊液葡萄糖水平[中位数(四分位数):1.8(1.4,2.3)mmol/L]、氯化物[(109.37±13.68)mmol/L]降低,蛋白[中位数(四分位数):1994.5(1257.5,2888.3)g/L]升高。77例患者中预后良好者41例,预后不良者36例。预后良好组瘫痪的发生率为7.3%(3/41)明显低于预后不良组的41.7%(15/36),差异有统计学意义(χ~2=12.63,P=0.000)。根据格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分,预后良好组轻度昏迷(13～14分)、中度昏迷(9 12分)、重度昏迷(3～8分)者分别占34.1%(14/41)、61.0%(25/41)、4.9%(2/41);预后不良组轻度昏迷、中度昏迷、重度昏迷者分别占0.0%(0/36)、55.6%(20/36)、44.4%(16/36);两组比较,差异有统计学意义(χ~2=4.99,P=0.000)。logistic回归分析显示,发生瘫痪[OR (95%CI):10.75 (1.53～76.92)]和重度昏迷[OR (95%CI):22.33 (4.56～109.21)]的HIV阴性TBM患者预后较差。结论发热、盗汗、头痛是HIV阴性TBM最常见的临床症状。瘫痪和GCS评分差是HIV阴性TBM患者预后不良的独立危险因素。更多还原

【Abstract】 Objective To analyze the clinical characteristics and prognostic factors of human immunodeficiency virus(HIV) negative tuberculous meningitis(TBM) patients.Methods The clinical data of 77 patients with HIV negative TBM clinically diagnosed in the department of tuberculosis The Fifth People’s Hospital of Suzhou from January 2012 to December 2017 were retrospectively analyzed.According to the modified Rankin scale(mRS) score at discharge,patients were divided into the group with good prognosis(mRS score:0-2) and the group with poor prognosis(mRS score:3-6).The clinical characteristics of patients in the good prognosis group and the poor prognosis group were compared,and the risk factors affecting the prognosis of patients were analyzed by conditional logistic stepwise regression.Results Among the 77 patients,the common clinical symptoms were headache(68 cases,88.3%),fever(75 cases,97.4%) and night sweats(69 cases,89.6%).CSF glucose levels(median(quartile):1.8(1.4,2.3) mmol/L),chloride((109.37±13.68) mmol/L) decreased,and protein(median(quartile):1994.5(1257.5,2888.3) g/L) increased.Among the 77 patients,41 had a good prognosis and 36 had a bad prognosis.The incidence of paralysis in the well-prognosis group was 7.3%(3/41),significantly lower than that in the poor-prognosis group(41.7%,15/36),and the difference was statistically significant(chi-square=12.63,P=0.000).According to Glasgow coma score,patients with mild coma(13-14 points),moderate coma(9-12 points)and severe coma(3-8 points) in the group with good prognosis accounted for 34.1%(14/41),61.0%(25/41) and4.9%(2/41),respectively.The patients with mild coma,moderate coma and severe coma in the group with poor prognosis accounted for 0.0%(0/36),55.6%(20/36) and 44.4%(16/36),respectively.The differences between the two groups were statistically significant(χ~2=4.99,P=0.000).Logistic regression analysis showed that hiv-negative TBM patients with paralysis(OR(95%CI):10.75(1.53-76.92)) and severe coma(OR(95%CI):22.33(4.56-109.21))had poor prognosis.Conclusion Fever,night sweats and headache are the most common clinical symptoms of hiv-negative TBM.Paralysis and poor GCS score were independent risk factors for poor prognosis in HIV-negative tuberculous meningitis patients.更多还原