摘要
目的探讨急诊科早期临床诊断结核性脑膜炎的方法。方法对北京协和医院1995年至2004年10年间出院诊断为结核性脑膜炎的患者进行回顾性分析。对患者有无结核病史、有无合并其他部位结核感染、脑脊液结果及细菌培养等结果进行分析。结果 68例患者中有16例既往有结核病史(24%),有20例结核性脑膜炎发病的同时患有肺结核(30%)、9例患者同时有肺结核以外的颅外结核(13%)。全部患者均进行了结核杆菌培养,其中12例为阳性结果(20%)。阳性率较高的7项临床指标依次是神志改变(100%),发病时间>5 d(99%),脑脊液以淋巴细胞为主(80%),脑脊液糖水平低于血糖水平50%(70%),CT 或 MRI 异常(70%),眼底异常(49%)及合并有其他部位结核(43%)。结论通过68例病例分析可见,结核性脑膜炎常合并其他部位结核感染。脑脊液及血等标本中结核菌培养阳性率低,不宜作为早期诊治的主要依据。建议临床工作中当出现上述7条指标中≥4条时应高度怀疑结核性脑膜炎。
Objective To find a method for the early diagnosis of tuberculous meningitis（TM）. Methods Cases with the discharge diagnosis of TM during 1995 -2004 ten years in the Peking Union Medical College Hospital were analyzed retrospectively. History of tuberculosis other sites of tuberculous infection, the findings Of cerebrospinal fluid （CSF） and CSF culture result were studied. Results 16 Of the 68 patients had past history Of tuberculosis. During hospitalization 20 had pulmonary tuberculosis, while 9 had other sites of tuberculous infection. The rate of tuberculous infection aside from neurological system was 43%. The top 7 clinical manifestations were： coma, onset of the disease more than 5 days, lymphocyte predominant in CSF, glucose level in CSF 50% lower than that Of blood, abnormal CT findings. Abnormal ocular fundi and proved tuberculosis of other sites. Conclusions TM is often accompanied with tuberculous infection of other sites. Its diagnosis can not be relied mainly on the culture result of CSf. When 4 of the 7 above mentioned criteria are present, TM should be diagnosed and anti-tuberculosis therapy started.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2007年第3期217-219,共3页
Chinese Journal of Internal Medicine
关键词
结核
脑膜
参考标准
诊断
早期
Tuberculosis, meningeal
Reference standards
Early diagnosis
