关键词: 结核, 脑膜, 预后, 儿童

Abstract: Objective To explore the risk factors influencing short-term prognosis of tuberculosis meningitis (TBM) in children．Methods The clinical records of 83 hospitalized children with TBM from January,1, 2008 to December,31, 2012 in Xi’an Tuberculosis and Chest Tumor Hospital were evaluated retrospectively．Fifty-three cases (63.9%) resulted in a good prognosis and 30 cases (36.1%) resulted in a poor prognosis．A total of 36 potential factors influencing short-term prognosis of TBM were firstly evaluated by Univariate analysis. A Student’s t-test (t) was used to compare the mean values of the continuous measurements, such as cerebrospinal fluid (CSF) analysis. Aχ² test (or Fisher’s exact test for small proportions) was used for categorical variables, such as age, gender, clinical manifestations, hydrocephalus. And then take the 10 variables with a statistically significant difference into the logistic regression，which was used to model the probability of having a poor prognosis. A P-value <0.05 was considered statistically significant difference. All statistical analyses were conducted on a personal computer with the SPSS for Windows (version 18.0) software package. Results The Univariate analysis revealed 10 factors associated with a poor short-term prognosis（P<0.05）: vomiting(the rates in the cases with a good prognosis and poor prognosis were 50.9%（27/53） and 76.7%（23/30）,χ²＝5.292), positive signs of meningeal irritation（the rates in the cases with a good prognosis and poor prognosis were 67.9%（36/53） and 100.0%（30/30）,χ²＝9.318）, cranial nerve involvements（the rates in the cases with a good prognosis and poor prognosis were 11.3%（6/53） and 33.3%（10/30）,χ²＝13.561）, paralysis（the rates in the cases with a good prognosis and poor prognosis were 5.7%（3/53） and 26.7%（8/30）,χ²＝7.353）, clinical stage of TBM（in the cases with a good prognosis the rates of early stage, middle stage and late stage were 26.4%（14/53）,56.6%（30/53） and 17.0%（9/53）,while in the cases with a poor prognosis the rates were 3.3%（1/30）, 30.0%（9/30） and 66.7%（20/30）,χ²＝22.162）, coma（the rates in the cases with a good prognosis and poor prognosis were 17.0%（9/53） and 60.0%（18/30）,χ²＝14.922），seizures（the rates in the cases with a good prognosis and poor prognosis were 22.6%（12/53） and 70.0%（21/30）,χ²＝17.939），obvious abnormalities in brain iconography（in the cases with a good prognosis the rates of normal brain iconography, hydrocephalus alone, intracranial lesions alone, hydrocephalus and intracranial lesions were 49.1%（26/53）, 32.1%（17/53）, 15.1%（8/53） and 3.7%（2/53）, while in the cases with a poor prognosis the rates were 16.7%（5/30）, 56.7%（17/30）, 6.7%（2/30） and 20.0%（6/30），χ²＝14.571）, elevated protein concentrations in CSF（the levels in the cases with a good prognosis and poor prognosis were （1.38±1.07）g/L and（2.29±1.93）g/L，t＝2.741）, decrease chlorine concentrations in CSF（the levels in the cases with a good prognosis and poor prognosis were （115.59±8.85）mmol/L,（109.55±7.83）mmol/L,t＝3.116）. Multivariate logistic analysis revealed that 3 independent risk factors for a poor short-term prognosis:coma (OR=13.670, 95%CI=4.268-43.768), hydrocephalus (OR=6.895，95%CI=1.439-33.031) and late-stage TBM (OR=10.580，95%CI=2.866-38.091).  Conclusion Coma, late-stage TBM and hydrocephalus are risk factors for a poor prognosis for children with TBM. Diagnosis and treatment as early as possible are the most important ways to improve the short-term prognosis.

Key words: Tuberculosis, meningeal, Prognosis, Child