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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (6): 632-639.doi: 10.3969/j.issn.1000-6621.2019.06.008

• 论著 • 上一篇    下一篇

164例结核性脑膜炎患者预后影响因素分析

黄威,安雪梅,刘旭晖,裴宁,刘萍,夏露,李涛,席秀红,黄琴,卢水华()   

  1. 201508 复旦大学附属上海市公共卫生临床中心结核科(黄威、安雪梅、刘旭晖、裴宁、刘萍、夏露、李涛、席秀红、卢水华),感染疾病科(黄琴)
  • 收稿日期:2019-03-18 出版日期:2019-06-10 发布日期:2019-06-04
  • 通信作者: 卢水华 E-mail:tubercle@shaphc.org

Analysis of prognostic factors in 164 tuberculous meningitis patients

Wei HUANG,Xue-mei AN,Xu-hui LIU,Ning PEI,Ping LIU,Lu XIA,Tao LI,Xiu-hong XI,Qin HUANG,Shui-hua LU()   

  1. Department of Tuberculosis, Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai 201508, China
  • Received:2019-03-18 Online:2019-06-10 Published:2019-06-04
  • Contact: Shui-hua LU E-mail:tubercle@shaphc.org

摘要:

目的 分析结核性脑膜炎(TBM)的临床特征及预后影响因素。方法 收集2014—2017年在复旦大学附属上海市公共卫生临床中心住院治疗的符合入组标准的164例临床确诊为初治TBM患者的临床资料,包括性别、年龄、卡介苗接种史、体温、脑膜刺激征、TBM严重程度[采用英国医学研究理事会(MRC)评价表评分分级]、脑脊液参数、头颅MR或CT表现(脑积液、脑梗死、脑脓肿或结核瘤、脑膜强化)、胸部CT表现、机械通气、结核感染T细胞斑点试验(T-SPOT.TB)、脑脊液病原学结果、起病2周内应用利奈唑胺的患者例数、预后结局(治疗后9个月内);并根据预后结局将患者分为预后良好组(95例)和预后不良组(69例)。采用条件logistic逐步回归的方法对影响两组患者预后的相关因素进行分析。结果 预后不良组在0~15岁(36.2%,25/69)、MRC Ⅲ级(58.0%,40/69)、脑梗死(45.2%,28/62)、脑积液(54.8%,34/62)、机械通气(19.4%,13/67)患者中的发生率均高于预后良好组[分别为17.9%(17/95)、20.0%(19/95)、4.3%(4/93)、11.8%(11/93)、5.4%(5/92)](χ 2=7.06,P=0.008;χ 2=25.02,P=0.000;χ 2=37.91,P=0.000;χ 2=33.40,P=0.000;χ 2=7.53,P=0.006),而2周内使用利奈唑胺的比率(8.7%,6/69)低于预后良好组(21.1%,20/95)(χ 2=4.58,P=0.032)。logistic回归分析显示,0~15岁[Wald χ 2=4.46,P=0.035,OR(95%CI)=3.51(1.09~11.22)]、MRC Ⅲ级[Wald χ 2=5.82,P=0.016,OR(95%CI)=3.95(1.29~12.09)]、脑梗死[Wald χ 2=22.82,P=0.000,OR(95%CI)=25.90(6.81~98.40)]、脑积液[Wald χ 2=19.13,P=0.000,OR(95%CI)=10.00(3.56~28.07)]是预后不良的危险因素,而早期加用利奈唑胺是保护因素[Wald χ 2=6.48,P=0.011,OR(95%CI)=0.14(0.03~0.64)]。结论 0~15岁、MRC Ⅲ级、脑梗塞、脑积液是TBM预后不良的主要危险因素,早期加用利奈唑胺可以改善其预后。

关键词: 结核, 脑膜, 预后, 危险因素, 因素分析, 统计学

Abstract:

Objective To analyze the clinical characteristics and prognostic factors of tuberculous meningitis (TBM) patients.Methods The clinical data of 164 patients with TBM clinically diagnosed in the Shanghai Public Health Clinical Center from January 2014 to December 2017, including sex, age, BCG vaccination, temperature, meningeal syndrome, TBM stage, indexes of cerebrospinal fluid, brain MR/CT, lung CT, using mechanical ventilation or not, T-SPOT.TB assay, the number of TBM patients who receiving linezolid within two weeks after onset, and outcomes within 9 months after starting treatment, were retrospectively analyzed. According to the outcome within 9 months after starting treatment, patients were divided into good prognosis group and poor prognosis group (death or neurological sequelae). The clinical datas of patients in the two groups were compared, and the risk factors affecting the prognosis of patients were analyzed by conditional logistic stepwise regression.Results Incidencesin the poor prognosis group, including aged 0-15-year (36.2% (25/69)), MRC grade Ⅲ (58.0% (40/69)), cerebral infarction (45.2% (28/62)), cerebral hydrocephalus (54.8% (34/62)) and mechanical ventilation (19.4% (13/67)), were statistically higher than those in good prognosis group (17.9% (17/95), 20.0% (19/95), 4.3% (4/93), 11.8% (11/93) and 5.4% (5/92)) (χ 2 values were 7.06, 25.02, 37.91, 33.40 and 7.53; all P<0.05); while the rate of TBM patients treated with linezolid at early stage in the poor prognosis group was lower than those in the good prognosis group (8.7% (6/69) vs. 21.1% (20/95)) and the differences were statistically significant (χ 2=4.58, P=0.032). Logistic regression analysis showed that 0-15 year old (OR (95%CI)=3.51 (1.09-11.22)), MRC grade Ⅲ (OR (95%CI)=3.95 (1.29-12.09)), cerebral infarction (OR (95%CI)=25.90 (6.81-98.40)), cerebral hydrocephalus (OR (95%CI)=10.00 (3.56-28.07)) were risk factors, whereas receiving linezolid at early stage (OR (95%CI)=0.14 (0.03-0.64)) was protective factor.Conclusion Young (0-15 years old), MRC grade Ⅲ, cerebral infarction and hydrocephalus are the main risk factors for poor prognosis in TBM patients. This study highlighted that the early use of linezolid could improve the prognosis.

Key words: Tuberculosis, meningeal, Prognosis, Risk factors, Factor analysis, statistical