关键词: 结核, 脑膜

Abstract: Objective To investigate the clinical and epidemiological features in patients with tuberculous meningitis (TBM), especially in migrant workers with TBM.  Methods We analyzed retrospectively the clinical data from 366 cases of TBM hospitalized from 1980 to 2008 by SPSS 11.5 statistical software.  Results (1)The group of migrant workers older than 14 years old with TBM accounted for 31.9% in the same age group of patients hospitalized druing the last 10 years. Most patients’age ranged from 16 to 38 years old. The children of migrant workers with TBM accounted for 71.4% in the same age group of patients hospitalized druing the last 10 years. (2) Cerebrospinal fluid(CSF) culture for mycobacterium tuberculosis was performed in 321 cases with 28 positive. CSF smear was performed in 60 cases with 4 positive. The common lesion sitewas basal ganglia among 70 cases(59.3%) in MRI or CT of brain. 76 cases(64.4%) were complicated with hydrocephalus. The finding rate of abnormal imaging in MRI was 84.7%, whichwere patching, small nodule, circled abnormal signal, equal or low signal in T₁W₁ and high signal in T₂W₁ and FLAIR. The finding rate of abnormal imaging in CT was 84.7%, which were patching, focal with low density, ventriculomegaly and hydrocephalus. Ring enhancement of exudative lesion was one of characteristics in MRI imaging. (3)Mortality in TBM was 14.2%. The causes of death were as follows: cerebral hernia in 30 cases(57.7%), septic shock in 10 cases(19.2%), systemic failure in 3 cases(5.77%) and gastrointestinal bleeding in 3 cases(5.77%). (4) Of 126 cases younger than 14 years old, 78 cases were from local and 12 cases were vaccinated by BCG(vaccinal scar in 3 cases), and 48 cases were children of migrant workers and 3 cases were vaccinated by BCG(vaccinal scar in 1 cases).  Conclusion  It is very important for diagnosis of TBM that the dectection rate of mycobaterium tuberculosis from CSF should be improved and other related detection Methods are developed. MRI should be one of the routine tool to diagnose TBM. The measures for successful treatment of TBM are rescue of cerebral hernia, effective anti-infection treatment, nutrition support, preventiong of gastrointestinal bleeding. Putting important attention to BCG vaccination and its quality can prevent effectively TBM. Because the incidence of TBM is increasing among migrant workers and their children and it is difficult to treat TBM. The point of tuberuclosis control should be on this kind of disease.

Key words: tuberculosis, meningeal