摘要
目的探讨不典型结核性脑膜炎(结脑)的临床分类、诊断和治疗方法.方法回顾性总结分析68例不典型结脑临床特点、诊断依据,采用3HS(E)RZ/9HRZ化疗方案,并用地塞米松、降颅压治疗.结果68例不典型结脑分为脑脊液改变不典型、脑脊液和临床表现均不典型两类;治疗结果67例存活,死亡1例,无明显后遗症.随访2年以上者64例.结论不典型结脑诊断参考:(1)活动性肺结核表现;(2)不典型脑脊液改变或/和不典型结脑临床表现;(3)抗结核试验治疗有效;(4)除外非结脑疾病;(5)脑脊液PPD抗体阳性、腺苷脱氨酶(ADA)增高;(6)CT或MR符合结脑影像;(7)病理显示结核样改变或脑脊液检出抗酸杆菌;具备1～6项中3项或第7项可诊断.采用HS(E)RZ四联12个月化疗,安全、有效.
Objective To study the clinical diagnosis and treatment of untypical tuberculosis meningitis （TBM）. Method To analysis the clinical characteristics and the diagnosis basis on the 68 untypical TBM casesrespectively. 3HS（E）RZ/gHRZ treatment regimen were adapted, DXM were used as well as to lower the head pressure. Results Sixty-eight cases were divided into two categories. Among them, 67 cases are alive, one died, and no sequel left. Furthermore , 64 cases have been followed up for over 2 years. Conclusions Diagnosis of untypical TBM can be based on the basis of following manifestations ： （ 1 ） Manifestations of active pulmonary tuberculosis . （2）Changes of untypical cerebrospinal fluid （CSF） or/and manifestations of untypical TBM. （3） The experiment antituberculotic therapy is effect. （4）Non - TBM diseases can be excepted. （5）PPD antibody in CSF is positive , ADA in CSF is high. （6）Images of head CT and MRI accord with TB changes. （7）Tuberculotical mycobacterium can be found in CSF. If there are 3 items in the anterior 6 or possesses the 7th items alone, the untypical TBM can be determined, and to adapt HS（E）RZ that four drugs are union as a twelve month chemical therapy will be safe and effective.
出处
《中国防痨杂志》
CAS
2005年第6期364-366,共3页
Chinese Journal of Antituberculosis
关键词
结核
脑膜
诊断
治疗
Tuberculosis, Meninx
Diagnosis
Treatment
