《儿童中枢神经系统结核的诊断》团体标准解读

doi:10.19982/j.issn.1000-6621.20220425

摘要/Abstract

摘要：

2022年9月,中国防痨协会发布了《儿童中枢神经系统结核的诊断》团体标准。本文就该标准核心要点进行解读,皆在进一步帮助临床儿科医师及结核病诊疗人员早期识别儿童中枢神经系统结核,加强本病诊断的规范性。

Abstract:

The Social Organization Standard for Diagnosis of central nervous system tuberculosis in children was published by the Chinese Antituberculosis Association in September 2022. In order to make this standard implied comprehensively, we give some additional interpretations of the recommendations for the diagnosis of central nervous system tuberculosis in children.

Key words: Child, Tuberculosis, central nervous system, Diagnosis, Guidebooks

中图分类号:

R529.9
C65

王泽明, 申阿东. 《儿童中枢神经系统结核的诊断》团体标准解读[J]. 中国防痨杂志, 2023, 45(1): 18-24. doi: 10.19982/j.issn.1000-6621.20220425

Wang Zeming, Shen Adong. Interpretation of Social Organization Standard of Diagnosis of central nervous system tuberculosis in children[J]. Chinese Journal of Antituberculosis, 2023, 45(1): 18-24. doi: 10.19982/j.issn.1000-6621.20220425

图/表 2

图1

表1

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诊断评分项目	评分(分)
接触史及临床表现	最高计6分
症状持续时间≥5d	4
包含1种或多种结核中毒症状(如体质量减轻、盗汗等);或持续咳嗽≥2周	2
1年内与传染性结核病患者密切接触,或结核菌素皮肤试验/γ-干扰素释放试验阳性者(仅限于<10岁儿童)	2
局灶性神经功能缺损(不包括脑神经麻痹)	1
脑神经麻痹	1
意识状态改变	1
脑脊液检查	最高计4分
外观透明	1
细胞数为(10~500)×10⁶/L	1
淋巴细胞占比>50%	1
蛋白质>1g/L	1
葡萄糖<2.2mmol/L或低于血糖的50%	1
头颅影像学检查	最高计6分
结核瘤	2
基底脑池的脑膜强化	2
平扫时颅底脑池变窄,密度增高	2
脑积水	1
脑梗死	1
其他部位结核病证据	最高计4分
胸部影像学提示活动性肺结核(肺结核2分,粟粒型肺结核4分)	2/4
CT、MRI、超声检查提示存在颅外其他系统结核	2
脑脊液以外的标本(痰液、淋巴结、胃液、尿液、血液等)抗酸染色或MTB培养阳性	4
脑脊液以外的标本(痰液、淋巴结、胃液、尿液、血液等)MTB分子生物学检测阳性	4
排除诊断通过病原学(涂片抗酸染色、培养或分子生物学检测)、免疫学或病理学检查,除外其他疾病,如化脓性脑膜炎、病毒性脑膜脑炎、隐球菌性脑膜炎、梅毒性脑膜炎、脑型疟疾、寄生虫性脑膜炎、嗜酸性粒细胞增多性脑膜炎、弓形体脑病、颅内占位性病变(如脑脓肿、恶性肿瘤等)