154例结核性脑膜炎患者临床特征及预后影响因素研究

发布时间：2018-03-19 19:27

本文选题：结核性脑膜炎　切入点：临床表现　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:总结结核性脑膜炎临床表现,实验室检查、影像学改变、脑电图变化,分析影响预后因素,为结核性脑膜炎诊治提供指导。方法:采用回顾性研究方法,收集了2012年6月至2015年8月于重庆医科大学附属第一医院诊断结核性脑膜炎的154例住院患者临床资料,随访其预后,并探讨可能影响预后的危险因素。结果:(1)本试验共纳入结核性脑膜炎患者154例,男性占57%(87例),平均年龄为41岁。(2)头痛、发热、颈项强直为结核性脑膜炎患者最常见临床表现,52.6%(81例)的患者同时出现上述症状,92.9%(143例)患者出现头痛、发热、颈项强直症状中至少两项。(3)结核性脑膜炎患者常有中枢神经系统外其他部位结核病变,其中肺结核最常见(71例,50.7%)。(4)15.2%(5/33)患者死于全身并发症,老年人较年轻人更容易出现全身并发症。肺部感染和消化道出血是最常见的全身并发症,两者均可能与预后不良有关,且消化道出血可能延长住院时间。(5)在本试验中,肢体瘫痪、低GCS评分、颅神经麻痹及脑积水为预后不良独立危险因素。(6)外周血中性粒细胞/淋巴细胞升高,D-二聚体升高,血浆白蛋白/球蛋白升高可能与预后不良有关。(7)结核性脑膜炎最显著脑电图改变为基本背景活动慢化及痫样放电,基本背景活动慢化可能提示预后不良。(8)在远期随访中,47例(31%)预后不良,33例死亡(21%),其中16例(10%)于住院期间死亡,94%死亡病例发生于发病后1年内。结论:中国结核性脑膜炎患者致残率和致死率很高。GCS评分、颅神经麻痹及脑积水为预后不良独立危险因素,外周血中性粒细胞/淋巴细胞,D-二聚体,血浆白蛋白/球蛋白及脑电图背景慢波活动可能与预后相关。
[Abstract]:Objective: to summarize the clinical manifestations, laboratory examination, imaging changes, electroencephalogram (EEG) changes and prognostic factors of tuberculous meningitis, and to provide guidance for diagnosis and treatment of tuberculous meningitis. The clinical data of 154 cases of tuberculous meningitis diagnosed in the first affiliated Hospital of Chongqing Medical University from June 2012 to August 2015 were collected and their prognosis was followed up. Results: a total of 154 patients with tuberculous meningitis were included in the study. Cervical ankylosis is the most common clinical manifestation of tuberculous meningitis. At least two of the symptoms of cervical ankylosis.) patients with tuberculous meningitis often have tuberculosis in other parts of the central nervous system. Among them, the most common cases of pulmonary tuberculosis are 50.7%, 50.72% and 15.2% 33) patients died of systemic complications. Pulmonary infection and gastrointestinal hemorrhage are the most common systemic complications, both of which may be associated with poor prognosis, and gastrointestinal bleeding may prolong hospital stay. Limb paralysis, low GCS score, cranial nerve palsy and hydrocephalus were independent risk factors for poor prognosis. The elevation of plasma albumin / globulin may be associated with poor prognosis. The most significant EEG changes in tuberculous meningitis are the slowness of basic background activity and epileptiform discharge. Basic background activity slowness may indicate poor prognosis.) during the long term follow-up, 47 patients (31 / 31) with poor prognosis (21 / 21) died of poor prognosis (16 / 10) and 94% of the deaths occurred within 1 year after the onset of the disease. Conclusion: tuberculous disease occurred in China. The disability rate and fatality rate of meningitis patients were very high. GCS score, Cranial nerve palsy and hydrocephalus were independent risk factors for poor prognosis. Peripheral blood neutrophil / lymphocyte D-dimer, plasma albumin / globulin and EEG background slow wave activity may be related to prognosis.
【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

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