结核性脑膜炎评分标准的临床适用性评价及结脑预后影响因素的分析

发布时间：2018-05-11 11:08

本文选题：结核性脑膜炎 + 结脑评分标准　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:1、了解结核性脑膜炎评分标准诊断效能,评估该评分标准在临床上的适用性;2、探讨结核性脑膜炎患者预后不良的影响因素。方法:回顾性收集2012年1月至2016年12月在广西医科大学第一附属医院住院且出院诊断为“结核性脑膜炎”或“结核性脑膜脑炎”或“结核性脑脊髓膜炎”病例的临床资料,排除重复住院、病历资料不完整、脑脊液病原学找到细菌或真菌证据、长期用药方案包含抗真菌药物以及失访的病例。采用结核性脑膜炎评分标准对每例患者进行评分并根据评分总分依次分为确诊组、很可能组、可能组及不可能组。通过电话随访患者或熟知患者病情及现状的家属,一方面了解有无误诊病例,以随访确诊方法作为参照,计算结核性脑膜炎评分标准的诊断灵敏度;另一方面对患者使用改良Rankin量表评分(modified Rankin Scale,mRS)并根据mRS评分情况对患者预后进行分组(mRS3分为预后良好,mRS≥3分为预后不良),分析预后不同两组病例的临床资料,进一步探讨结核性脑膜炎患者预后不良的影响因素。结果:(1)结核性脑膜炎评分标准的效能评价:根据结核性脑膜炎评分标准,纳入确诊组0例,很可能组56例(32.75%),可能组109例(63.74%),不可能组6例(3.51%);根据随访结果,确诊为结核性脑膜炎为157例(91.81%),确诊为非结核性脑膜炎为14例(8.19%)。以随访结果分组方法作参照,计算出结核性脑膜炎评分标准诊断的灵敏度为96.18%;(2)影响预后的危险因素:对随访确诊为结核性脑膜炎的157例患者根据mRS评分再次分组,其中预后良好组129例(82.17%),预后不良组28例(17.83%)。对2组患者的病例资料中可能与预后相关的各项因素进行单因素统计学分析,结果显示性别、病理征阳性、意识障碍、脑积水、脑梗死、结核瘤、是否鞘注、是否早期应用糖皮质激素、糖皮质激素使用方式、开始抗结核距离发病的时长、脑脊液蛋白、脑脊液氯化物共12个单因素在2组之间的差异具有统计学意义(P0.05)。对以上有统计学意义的变量进行二元logistic逐步回归分析,开始抗结核距离发病的时长(P=0.001,OR=1.017,95%CI:1.007~1.028)、意识障碍(P=0.004,OR=4.324,95%CI:1.578~11.851)、病理征阳性(P=0.011,OR=3.968,95%CI:1.368~11.505)为预后不良的独立危险因素。结论:(1)结核性脑膜炎评分标准在早期诊断结核性脑膜炎中具有良好的预测价值,可以在临床上积极推广使用;(2)开始抗结核距离发病的时长、意识障碍、病理征阳性是结核性脑膜炎预后不良的独立危险因素;(3)早期诊断和治疗对于改善结核性脑膜炎预后有关键作用。
[Abstract]:Objective to investigate the diagnostic efficacy of tuberculous meningitis scoring criteria and evaluate the clinical applicability of the criteria to explore the factors affecting the poor prognosis of patients with tuberculous meningitis. Methods: the clinical data of patients with tuberculous meningitis or tuberculous meningitis were collected retrospectively from January 2012 to December 2016 in the first affiliated Hospital of Guangxi Medical University. Exclusion of repeated hospitalization incomplete medical records cerebrospinal fluid etiology found evidence of bacteria or fungi long-term regimen including antifungal drugs and missing cases. According to the total score of tuberculous meningitis, the patients were divided into the definite group, the probable group, the possible group and the impossible group. The diagnostic sensitivity of tuberculous meningitis score was calculated by telephone follow-up or family members who were familiar with the condition and current situation of the patients, on the one hand, to find out whether there were misdiagnosis cases, and to calculate the diagnostic sensitivity of tuberculous meningitis score standard with the method of follow-up. On the other hand, the patients were evaluated with modified Rankin scale (modified Rankin scale / mRSs) and according to the mRS score, the patients were divided into two groups: good prognosis and poor prognosis. The clinical data of the two groups with different prognosis were analyzed. To further explore the prognostic factors of tuberculous meningitis. Results the effectiveness evaluation of tuberculous meningitis score: according to the tuberculous meningitis score standard, there were 0 cases in the diagnosed group, 56 cases in the most likely group, 63.74% in 109 cases, 6 cases in the impossible group, according to the results of follow-up. 157 cases were diagnosed as tuberculous meningitis and 14 cases as non-tuberculous meningitis. The sensitivity of diagnostic criteria for tuberculous meningitis was 96.18 / 2) and the prognostic risk factors were calculated. According to the mRS score, 157 patients with tuberculous meningitis were subdivided into two groups. There were 129 cases with good prognosis (82.17 cases) and 28 cases with poor prognosis (17.83%). Univariate statistical analysis was carried out on the factors related to prognosis in the case data of the two groups. The results showed that sex, positive pathological sign, disturbance of consciousness, hydrocephalus, cerebral infarction, tuberculoma, sheath injection or not. Whether the early use of glucocorticoid, glucocorticoid use mode, the onset of anti-tuberculosis time, cerebrospinal fluid protein, cerebrospinal fluid chloride a total of 12 single factors between the two groups had statistical significance (P 0.05). The binary logistic stepwise regression analysis of the above statistically significant variables showed that the time between the onset of anti-tuberculosis and the onset of tuberculosis was 1.01795 CI: 1.007 / 1.007 / 1.028, P0.004: 4.3245CIW 1.57811.851. the positive pathological sign P0.011ORT 3.969595 CIW 1.368Cw 11.505) were independent risk factors for poor prognosis. Conclusion the score standard of tuberculous meningitis has good predictive value in early diagnosis of tuberculous meningitis, and can be popularized in clinical practice. Positive pathological sign is an independent risk factor for poor prognosis of tuberculous meningitis. Early diagnosis and treatment play a key role in improving prognosis of tuberculous meningitis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R529.3

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