87例儿童结核性脑膜炎并脑积水的临床特征分析

发布时间：2018-01-14 15:05

本文关键词：87例儿童结核性脑膜炎并脑积水的临床特征分析　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨儿童结核性脑膜炎并发脑积水的临床资料,并分析影响其近期预后的相关因素。方法:对2011年1月至2016年12月重庆医科大学附属儿童医院收治的87例结核性脑膜炎并发脑积水患儿病例资料进行回顾性分析。结果:(1)本研究87例儿童结核性脑膜炎并脑积水中,5岁占60%、5-10岁占24%、10岁占16%,其中婴幼儿占44%。64%来自农村。(2)59%(51/87)有卡介苗接种史,34%(30/87)无卡介苗接种史,余卡介苗接种史不详。38%(33/87)有明确结核接触史,其中61%(20/33)为婴幼儿。87%(76/87)合并颅外结核,均合并肺结核(100%,76/76)。(3)临床分期为早期、中期、晚期分别占15%(13/87)、31%(27/87)、54%(47/87)。74%(64/87)脑积水出现在病程4周以内,确诊时CT/MRI的检查次数为1~3次。(4)临床症状按阳性率从高到低依次为:发热(94%,82/87)、颅高压症状(86%,75/87)、其他结核中毒症状(83%,72/87)、意识障碍(83%,72/87)、惊厥(61%,51/87)、精神行为异常(17%,15/87)、不自主运动(13%,13/87)、大小便失禁(5%,4/87)、失语(2%,2/87)。神经系统体征按阳性率从高到低依次为:脑膜刺激征(83%,72/87)、瘫痪(67%,58/87)、巴氏征(62%,54/87)、颅神经麻痹(47%,41/87)。其中颅神经麻痹以面神经(59%,24/41)、动眼神经(54%,22/87)受损最常见,其次为外展神经(15%,6/41)、视神经(10%,4/41)。(5)35%(27/77)找到脑脊液病原学证据,脑脊液涂片、培养阳性率分别为18%、27%。(6)60%(46/77)临床疑诊结核性脑膜炎的患儿首次行脑脊液检查呈典型改变。(7)头颅影像学(MRI/CT)检查以基底节病变(72%/33%)、脑实质病变(83%/29%)、脑池改变(39%/5%)、脑膜改变(24%/3%)为主要表现。(8)单因素分析显示:临床分期、惊厥、意识障碍、脑膜刺激征、巴氏征、瘫痪、住院时间、鞘内注射、抗结核治疗在预后上的差异具有统计学意义(P0.05)。经多因素logistic回归分析后显示临床分期(P=0.006,OR=3.888,95%CI 1.486~10.167)、意识障碍(P=0.026,OR=14.238,95%CI 3.827~147.122)是儿童结核性脑膜炎并脑积水近期预后不良的危险因素,鞘内注射(P=0.006,OR=0.148,95%CI 0.039~0.572)是儿童结核性脑膜炎并脑积水近期预后的保护因素。结论:1.儿童TBMH多见于5岁以下儿童,特别是婴幼儿,主要来自农村。2.以发热、呕吐、惊厥、意识障碍、脑膜刺激征、巴氏征、瘫痪、颅神经损害为突出临床表现。3.头颅MRI检查效果优于CT。4.合并颅外结核以肺结核最常见。5.绝大部分临床分期为中晚期,脑积水出现时间以病程4周内常见。6.临床分期、惊厥、意识障碍、脑膜刺激征、巴氏征、瘫痪与近期预后不良有关。住院时间延长、鞘内注射、规范抗结核治疗可改善预后。其中临床分期、意识障碍是独立危险因素,鞘内注射是独立保护因素。
[Abstract]:Objective: to investigate the clinical data of tuberculous meningitis complicated with hydrocephalus in children. The factors related to its short-term prognosis were analyzed. Methods:. From January 2011 to December 2016, 87 cases of tuberculous meningitis complicated with hydrocephalus in Children's Hospital affiliated to Chongqing Medical University were retrospectively analyzed. 1) 87 children with tuberculous meningitis complicated with hydrocephalus. Among them, 44% of infants (44%) came from rural areas and 51% (51 / 87) had a history of BCG inoculation (5 years old, 60%, 5-10 years old, 24 cases, 10 years old, 16 cases), in which 44% of the infants came from the countryside, and 51% of them had BCG vaccination history. There was no history of BCG vaccination, while the history of BCG inoculation was not known. 38% (33 / 87) had a history of contact with tuberculosis. Among them, 61R / 20 / 33) is infantile. 87% 76 / 87) complicated with extracranial tuberculosis. All of them are complicated with pulmonary tuberculosis (100%). The clinical stage is early and middle stage. The late stage accounted for 13 / 87 / 31 of 27 / 87 / 54 / 47 / 87 / 74, respectively. Hydrocephalus appeared within 4 weeks of the course of the disease. At the time of diagnosis, the number of CT/MRI examinations was 1 / 3. 4) the positive rate of clinical symptoms from high to low was as follows: fever 94 / 82 / 87, cranial hypertension 86 / 87). Other TB poisoning symptoms 832 / 87, conscious disorders 82 / 87, convulsions 61 / 87, mental and behavioral disorders 17 / 87). 13 / 87% of involuntary exercise, 5 / 87% of incontinence in feces and urine, and 2% of aphasia. The positive rate of nervous system signs from high to low was 83% of meningeal stimulation, 67% of 87% of paralysis, 62% of pasteurization and 54% 87% of pasteurization). The cranial nerve palsy is 41 / 87. The most common type of cranial nerve palsy is the facial nerve 59 / 41, the oculomotor nerve 54 / 87) and the oculomotor nerve 542 / 87). The next is the abducent nerve 15 / 41, the optic nerve 1010 / 4 / 41t / 45 / 77) and the cerebrospinal fluid (CSF) smear, the evidence of cerebrospinal fluid (CSF) pathogeny is found, and the cerebrospinal fluid (CSF) smear is obtained. The positive rate of culture was 18%. Patients suspected of tuberculous meningitis underwent cerebrospinal fluid (CSF) examination for the first time. 72 / 33). Brain parenchymal lesions, brain cisterns, brain cisterns, brain cisterns, brain cisterns, brain cisterns, meningeal changes, and 24 / 3, as the main manifestation, single factor analysis showed: clinical staging, convulsion, and disturbance of consciousness. Meningeal stimulation, pasteurization, paralysis, length of stay, intrathecal injection. The difference in prognosis of anti-tuberculosis therapy was statistically significant (P 0.05). The clinical staging was demonstrated by multivariate logistic regression analysis (P0. 006) and OR3. 888 (P < 0. 006). 95 CI 1.486 ~ 10.167%, and the disturbance of consciousness is 0.026 ~ 14.238. 95 CI 3.827 ~ 147.122) is the risk factor of poor prognosis in children with tuberculous meningitis and hydrocephalus. 95 CI 0.039 0. 572) is a protective factor for children with tuberculous meningitis and hydrocephalus. Conclusion TBMH in children is more common in children under 5 years of age, especially in infants. Mainly from rural areas. 2. With fever, vomiting, convulsion, disturbance of consciousness, meningeal stimulation sign, pasteurization sign, paralysis. Cranial nerve damage was prominent clinical manifestation .3.The effect of MRI was better than that of CT.4.The most common type of pulmonary tuberculosis was tuberculosis. Most of the clinical stages were middle and late stage. Clinical stage, convulsion, disturbance of consciousness, meningeal stimulation sign, pasteurization sign, paralysis were related to the poor prognosis in the near future, prolonged hospitalization and intrathecal injection. Standard antituberculous therapy can improve prognosis, among which clinical stage, consciousness disorder is an independent risk factor, intrathecal injection is an independent protective factor.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R529.3;R742.7

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