糖皮质激素联合四联抗结核药物治疗老年结核性脑膜炎的疗效及对脑脊液细胞学的影响

发布时间：2018-01-27 03:19

本文关键词： 结核性脑膜炎糖皮质激素抗结核药物脑脊液细胞学　出处：《中国老年学杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨糖皮质激素联合四联抗结核药物治疗老年结核性脑膜炎(TBM)的疗效及对脑脊液(CSF)细胞学的影响。方法该院收治的老年TBM患者107例随机分为观察组52例和对照组55例,均给予2异烟肼(H)+利福平(R)+乙胺丁醇(E)+吡嗪酰胺(Z)/4异烟肼(H)+利福平(R)方案抗结核治疗,观察组在此基础上给予糖皮质激素治疗。治疗3个月后,比较两组患者的临床疗效及症状改善情况,记录两组发热及意识障碍恢复时间,检测治疗前后两组CSF指标白细胞(WBC)、葡萄糖、氯化钠(Na Cl)及蛋白质(Pro)含量变化,记录治疗过程中不良反应的发生情况。结果观察组发热及意识障碍恢复时间均较对照组缩短(P0.05),临床症状改善较对照组显著(P0.05);观察组总有效率显著高于对照组(P0.05);治疗后两组CSF中WBC、Pro水平均较治疗前降低,Na Cl、葡萄糖均较治疗前升高,且观察组各指标水平变化均较对照组明显(均P0.05),两组不良反应发生率比较无统计学差异(P0.05)。结论糖皮质激素与四联抗结核药物联用治疗老年TBM能显著提高疗效,缓解临床症状,可通过改善炎性状态、减轻CSF细胞学损伤而发挥治疗作用,不良反应少,值得临床推广。
[Abstract]:Objective to evaluate the efficacy of glucocorticoid combined with antituberculosis drugs in the treatment of senile tuberculous meningitis (TBM) and its effect on cerebrospinal fluid (CSF). Methods 107 elderly patients with TBM were randomly divided into observation group (n = 52) and control group (n = 55). All patients were treated with 2 isoniazid (H) rifampicin (R) ethambutanol (E) pyrazinamide / 4 isoniazid (H) rifampicin). The observation group was treated with glucocorticoid on this basis. After 3 months of treatment, the clinical efficacy and symptom improvement of the two groups were compared, and the recovery time of fever and disturbance of consciousness were recorded. Before and after treatment, the changes of WBC, glucose, sodium chloride (NaCl) and protein (Proprol) in the two groups of CSF were detected. Results the recovery time of fever and disturbance of consciousness in the observation group was shorter than that in the control group (P 0.05), and the improvement of clinical symptoms was more significant than that in the control group (P 0.05). The total effective rate in the observation group was significantly higher than that in the control group (P 0.05). After treatment, the levels of CSF in the two groups were lower than those before treatment, and the glucose levels were higher than those before treatment, and the changes of each index in the observation group were significantly higher than those in the control group (all P 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P 0.05). Conclusion the combination of glucocorticoid and antituberculous drugs in the treatment of elderly TBM can significantly improve the efficacy and alleviate the clinical symptoms. It can play a therapeutic role by improving the inflammatory state and alleviating the CSF cytological injury, and the adverse reactions are few, which is worth popularizing in clinic.
【作者单位】：牡丹江医学院红旗医院传染科;牡丹江医学院红旗医院神经内二科;
【分类号】：R529.3
【正文快照】： 1牡丹江医学院红旗医院神经内二科结核性脑膜炎(TBM)是因感染结核分枝杆菌而引起脑膜和脊膜的非化脓性炎症,约占中枢神经系统结核病的70%左右〔1〕。以规律抗结核治疗为主,常以2~4种抗结核药物联合应用多见〔2〕。糖皮质激素有强大的抗感染功效,能显著改善TBM患者脑水肿程度,

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