中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (11): 1203-1210.doi: 10.3969/j.issn.1000-6621.2019.11.011
王曼知,陈芳(),危松青,周海依,胡锦跃,谢和宾,张小佛,李嘉,石家云,吴蕾
收稿日期:
2019-06-17
出版日期:
2019-11-10
发布日期:
2019-12-05
WANG Man-zhi,CHEN Fang(),WEI Song-qing,ZHOU Hai-yi,HU Jin-yue,XIE He-bin,ZHANG Xiao-fo,LI Jia,SHI Jia-yun,WU Lei
Received:
2019-06-17
Online:
2019-11-10
Published:
2019-12-05
摘要:
目的 分析结核性脑膜炎(tuberculous meningitis, TBM)伴意识障碍患者的预后影响因素。方法 回顾性分析2013年1月至2019年1月长沙市中心医院112例临床诊断为TBM伴意识障碍患者的资料,其中21例(18.8%)为确诊TBM患者,84例(75.0%)为高度可能的TBM患者,7例(6.2%)为可能的TBM患者。根据患者出院时改良Rankin量表(mRS)评分情况,将患者分为预后良好组48例(42.9%),预后不良组64例(57.1%)。预后良好组男性24例,中位年龄[M(Q1,Q3)]18.50(5.31,33.75)岁,中位病程20.00(11.25,30.00)d。预后不良组男性20例,中位年龄27.00(3.06,49.75)岁,中位病程15.00(10.00,20.00)d。采用logistic回归分析影响患者预后不良的影响因素。结果 单因素分析结果显示,住院时间(Z=-1.982,P=0.048)、性别(χ 2=4.043, P=0.044)、疾病分期(χ 2=17.733, P=0.000)、抽搐(χ 2=8.054, P=0.005)、低钠血症(χ 2=9.481, P=0.002)、脑水肿(χ 2=4.386, P=0.036)、脑积液(χ 2=5.992, P=0.014)对TBM伴意识障碍患者预后不良有一定影响。logistic回归分析显示,低钠血症(P=0.043, OR=2.784, 95%CI:1.034~7.495)、疾病分期为Ⅲ期(P=0.002, OR=6.855, 95%CI:2.001~23.480)、脑水肿(P=0.030, OR=3.491, 95%CI:1.132~10.768)是预后不良的危险因素。 结论 低钠血症、疾病分期为Ⅲ期、脑水肿是TBM伴意识障碍患者的预后不良的影响因素。
王曼知,陈芳,危松青,周海依,胡锦跃,谢和宾,张小佛,李嘉,石家云,吴蕾. 结核性脑膜炎伴意识障碍患者的预后影响因素分析[J]. 中国防痨杂志, 2019, 41(11): 1203-1210. doi: 10.3969/j.issn.1000-6621.2019.11.011
WANG Man-zhi,CHEN Fang,WEI Song-qing,ZHOU Hai-yi,HU Jin-yue,XIE He-bin,ZHANG Xiao-fo,LI Jia,SHI Jia-yun,WU Lei. Analysis of influencing factors for prognosis of tuberculous meningitis patients with consciousness disorder[J]. Chinese Journal of Antituberculosis, 2019, 41(11): 1203-1210. doi: 10.3969/j.issn.1000-6621.2019.11.011
表1
TBM的诊断评分及其鉴别诊断的排除评分[10]
诊断评分 | 评分 |
---|---|
临床表现 | 该层最高得分6分 |
症状持续≥5d(以下 1 项或多项临床表现:头痛、呕吐、易激惹、发热、颈项强直、癫痫发作、局灶性神经损害症状、意识改变) | 4 |
疑似结核的全身症状(1项或多项以下表现):体质量下降(或儿童体质量增长不良),盗汗、持续咳嗽>2周 | 2 |
过去1年内有结核密切接触史或TST、IGRA阳性者(仅限于10岁以内儿童) | 2 |
局灶神经损伤表现(不包括颅神经麻痹) | 2 |
颅神经麻痹 | 1 |
意识改变 | 1 |
脑脊液评分 | 该层最高得分4分 |
外观清亮 | 1 |
白细胞计数10~500个/μl 淋巴细胞比例>50% | 1 |
蛋白>1g/L | 1 |
脑脊液糖<2.2mol/L或低于血糖的50% | 1 |
头部影像学评分 | 该层最高得分6分 |
脑积液 | 1 |
脑基底膜增厚 | 2 |
脑结核瘤 | 2 |
脑梗死 | 1 |
脑基底部高密度影 | 2 |
其他部位结核证据 | 该层最高得分4分 |
胸片提示可疑的活动性结核灶:结核征象=2;粟粒型结核=4 | 2或4 |
CT/MRI/B超证实存在中枢神经系统外结核 | 2 |
其他标本(如痰、淋巴结、胃液、尿、血)中检测到抗酸杆菌或培养出结核分枝杆菌 | 4 |
中枢神经系统外的标本通过核酸扩增技术(NAAT)检测到结核分枝杆菌 | 4 |
鉴别诊断的排除 | 该层最高得分4分 |
采用微生物学(通过染色、培养、核酸扩增)、血清学(如梅毒)、组织学(如淋巴瘤)等方法来确定鉴别诊断。鉴别诊断列表的制定应考虑到年龄、机体免疫状态以及地理位置,包括:化脓性脑膜炎,隐球菌性脑膜炎,梅毒性脑膜炎,病毒性脑膜炎,脑型疟疾,寄生虫引起的或嗜酸细胞性脑膜炎,脑弓形体病和细菌性脑脓肿,恶性肿瘤(如淋巴瘤) |
表2
112例TBM伴意识障碍患者的诊断分类[10]
患者类型 | 病例数(例) | |
---|---|---|
确诊的TBM | 满足A或B的所有条件 A:满足临床表现评分标准同时至少符合以下1种情况:脑脊液检查发现抗酸杆菌;脑脊液分离培养到结核分枝杆菌;PCR方法检测到结核分枝杆菌 B:在脑或脊髓的组织学中找到结核分枝杆菌,并伴有可疑临床表现、体征或脑脊液改变,或尸检有肉眼可见的结核性脑膜炎改变 | 21 |
高度可能的TBM | 满足临床表现评分标准且总诊断评分≥10分(无脑影像学检查结果时)或者总诊断评分≥12分(有脑影像学检查结果时),同时需排除其他疾病。总得分中至少有2分来自脑脊液或脑影像学检查 | 84 |
可能的TBM | 满足临床表现评分标准且总诊断评分为6~10分(无脑影像学检查结果时)或者总诊断评分6~11分(有脑影像学检查结果时),同时需排除其他疾病。当未做腰椎穿刺或脑影像学检查时,可能的TBM不能被诊断或排除 | 7 |
表4
112例TBM伴意识障碍患者预后的单因素分析
影响因素 | 预后良好组(48例) | 预后不良组(64例) | 检验值 | P值 | ||||
---|---|---|---|---|---|---|---|---|
年龄[例(构成比,%)] | χ2=0.431 | 0.512 | ||||||
>18岁 | 24(50.0) | 36(56.2) | ||||||
≤18岁 | 24(50.0) | 28(43.8) | ||||||
性别[例(构成比,%)] | χ2=4.043 | 0.044 | ||||||
女 | 24(50.0) | 20(31.2) | ||||||
男 | 24(50.0) | 44(68.8) | ||||||
居住地[例(构成比,%)] | χ2=0.000 | 1.000 | ||||||
农村 | 39(81.2) | 52(81.2) | ||||||
城市 | 9(18.8) | 12(18.8) | ||||||
入院前病程[d, M(Q1,Q3)] | 20.81(10.00,20.00) | 26.22(11.25,30.00) | Z=-1.440 | 0.150 | ||||
住院时间[d, M(Q1,Q3)] | 55.50(41.00,68.25) | 39.00(18.75,69.00) | Z=-1.982 | 0.048 | ||||
疾病分期[例(构成比,%)] | χ2=17.733 | 0.000 | ||||||
Ⅰ期 | 5(10.4) | 2(3.1) | ||||||
Ⅱ期 | 38(79.2) | 32(50.0) | ||||||
Ⅲ期 | 5(10.4) | 30(46.9) | ||||||
抽搐[例(构成比,%)] | χ2=8.054 | 0.005 | ||||||
无 | 41(85.4) | 39(60.9) | ||||||
有 | 7(14.6) | 25(39.1) | ||||||
颅神经损伤[例(构成比,%)] | χ2=2.154 | 0.142 | ||||||
无 | 42(87.5) | 49(76.6) | ||||||
有 | 6(12.5) | 15(23.4) | ||||||
颈强直[例(构成比,%)] | χ2=0.239 | 0.625 | ||||||
无 | 8(16.7) | 13(20.3) | ||||||
有 | 40(83.3) | 51(79.7) | ||||||
病理征阳性[例(构成比,%)] | χ2=2.187 | 0.139 | ||||||
无 | 30(62.5) | 31(48.4) | ||||||
有 | 18(37.5) | 33(51.6) | ||||||
并发症[例(构成比,%)] | ||||||||
肺炎 | χ2=1.899 | 0.168 | ||||||
无 | 31(64.6) | 33(51.6) | ||||||
有 | 17(35.4) | 31(48.4) | ||||||
贫血 | χ2=2.172 | 0.141 | ||||||
无 | 21(43.8) | 37(57.8) | ||||||
有 | 27(56.2) | 27(42.2) | ||||||
低钠血症 | χ2=9.481 | 0.002 | ||||||
无 | 29(60.4) | 20(31.3) | ||||||
有 | 19(39.6) | 44(68.7) | ||||||
头颅影像学异常[例(构成比,%)] | ||||||||
脑积液 | χ2=5.992 | 0.014 | ||||||
无 | 37(77.1) | 35(54.7) | ||||||
有 | 11(22.9) | 29(45.3) | ||||||
脑水肿 | χ2=4.386 | 0.036 | ||||||
无 | 40(83.3) | 42(65.6) | ||||||
有 | 8(16.7) | 22(34.4) | ||||||
脑梗死 | χ2=0.321 | 0.571 | ||||||
无 | 29(60.4) | 42(65.6) | ||||||
有 | 19(39.6) | 22(34.4) | ||||||
脑脊液检查 | ||||||||
脑脊液压力[cm H2O, M(Q1,Q3)] | 212.50(150.00,350.00) | 250.00(140.00,337.50) | Z=-0.262 | 0.793 | ||||
脑脊液白细胞[×106个/L, M(Q1,Q3)] | 240.00(30.00,320.00) | 185.00(30.00,80.00) | Z=-1.736 | 0.083 | ||||
脑脊液白蛋白[g/L, M(Q1,Q3)] | 1.58(1.06,2.07) | 1.44(0.98,2.46) | Z=-0.050 | 0.960 | ||||
脑脊液糖[mmol/L, M(Q1,Q3)] | 1.99(1.32,2.69) | 1.81(1.14,2.62) | Z=-0.788 | 0.431 | ||||
脑脊液氯(mmo/L, | 112.33±10.43 | 112.01±9.53 | t=0.165 | 0.869 | ||||
血液检查 | ||||||||
白细胞计数[×109个/L, M(Q1,Q3)] | 8.51(6.19,12.15) | 9.99(6.30,12.12) | Z=-0.679 | 0.497 | ||||
中性粒细胞比率(%, | 73.86±16.03 | 76.89±13.64 | t=-1.082 | 0.282 | ||||
淋巴细胞比率[%, M(Q1,Q3)] | 17.68(7.65,24.93) | 15.70(4.78,23.78) | Z=-0.994 | 0.320 | ||||
血小板[×109个/L, M(Q1,Q3)] | 275.50(206.00,392.50) | 275.50(200.25,361.75) | Z=-0.079 | 0.937 | ||||
白蛋白[g/L, M(Q1,Q3)] | 38.54(34.70,43.15) | 40.29(30.50,41.08) | Z=-1.943 | 0.052 | ||||
球蛋白(g/L, | 28.16±5.91 | 28.84±7.19 | t=-0.534 | 0.594 | ||||
白蛋白/球蛋白( | 1.43±0.37 | 1.31±0.42 | t=1.507 | 0.135 | ||||
ESR[mm/1h, M(Q1,Q3)] | 34.65(14.00,44.00) | 31.69(12.25,40.00) | Z=-0.579 | 0.562 |
表6
TBM伴意识障碍患者预后多因素logistics回归分析
变量 | β值 | s | Wald χ2值 | P值 | OR值 | 95%CI值 |
---|---|---|---|---|---|---|
低钠血症 | 1.024 | 0.505 | 4.103 | 0.043 | 2.784 | 1.034~7.495 |
脑水肿 | 1.250 | 0.575 | 4.734 | 0.030 | 3.491 | 1.132~10.768 |
性别 | -0.961 | 0.517 | 3.462 | 0.063 | 0.382 | 0.139~1.053 |
住院时间 | -0.230 | 0.008 | 8.325 | 0.004 | 0.977 | 0.961~0.993 |
抽搐 | 1.150 | 0.587 | 3.841 | 0.050 | 3.157 | 1.000~9.971 |
疾病分期 | 10.709 | 0.005 | ||||
疾病分期(Ⅱ) | -0.790 | 1.062 | 0.553 | 0.457 | 0.454 | 0.057~3.641 |
疾病分期(Ⅲ) | 1.925 | 0.628 | 9.392 | 0.002 | 6.855 | 2.001~23.480 |
[1] |
World Health Organization . Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
doi: 10.1080/21645515.2019.1693720 URL pmid: 31730397 |
[2] |
Wilkinson RJ, Rohlwink U, Misra UK . Tuberculous meningitis. Nat Rev Neurol, 2017,13(10):581-598.
doi: 10.1038/nrneurol.2017.120 URL pmid: 28884751 |
[3] |
Mezochow A, Thakur K, Vinnard C . Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe. Curr Neurol Neurosci Rep, 2017,17(11):85-97.
doi: 10.1007/s11910-017-0796-0 URL pmid: 28932979 |
[4] |
James J . Central Nervous System Tuberculosis-The Gray Area in Tuberculosis Treatment. J Neurosci Rural Pract, 2019,10(1):6-7.
doi: 10.4103/jnrp.jnrp_229_18 URL pmid: 30765962 |
[5] |
Thwaites GE, van Toorn R, Schoeman J . Tuberculous meningitis: more questions, still too few answers. Lancet Neurol, 2013,12(10):999-1010.
doi: 10.1016/S1474-4422(13)70168-6 URL |
[6] |
Schaller MA, Wicke F, Foerch C , et al. Central Nervous System Tuberculosis: Etiology, Clinical Manifestations and Neuroradiological Features. Clin Neuroradiol, 2019,29(1):3-18.
doi: 10.1007/s00062-018-0726-9 URL pmid: 30225516 |
[7] |
Modi M, Goyal MK, Jain A , et al. Tuberculous meningitis: Challenges in diagnosis and management: Lessons learnt from Prof. Dastur’s article published in 1970. Neurol India, 2018,66(6):1550-1571.
doi: 10.4103/0028-3886.246224 URL pmid: 30504541 |
[8] |
Muzumdar D, Vedantam R, Chandrashekhar D . Tuberculosis of the central nervous system in children. Childs Nerv Syst, 2018,34(10):1925-1935.
doi: 10.1007/s00381-018-3884-9 URL pmid: 29978252 |
[9] |
Cathie IA . The streptomycin treatment of tuberculous meningitis. Postgraduate Medical Journal, 1948,3(273):29-36.
doi: 10.1007/s00108-019-0597-4 URL pmid: 30980098 |
[10] |
Marais S, Thwaites G, Schoeman JF , et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 2010,10(11):803-812.
doi: 10.1016/S1473-3099(10)70138-9 URL pmid: 20822958 |
[11] |
van Swieten JC, Koudstaal PJ, Visser MC , et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke, 1988,19(5):604-607.
doi: 10.1161/01.str.19.5.604 URL pmid: 3363593 |
[12] | 万红学, 卢雪峰 . 诊断学. 9版.北京: 人民卫生出版社, 2018. |
[13] |
Jain SK, Tobin DM, Tucker EW , et al. Tuberculous meningitis: a roadmap for advancing basic and translational research. Nat Immunol, 2018,19(6):521-525.
doi: 10.1038/s41590-018-0119-x URL pmid: 29777209 |
[14] |
Thao LTP, Heemskerk AD, Geskus RB , et al. Prognostic Models for 9-Month Mortality in Tuberculous Meningitis. Clin Infect Dis, 2018,66(4):523-532.
doi: 10.1093/cid/cix849 URL pmid: 29029055 |
[15] |
Misra UK, Kalita J, Bhoi SK , et al. A study of hyponatremia in tuberculous meningitis. J Neurol Sci, 2016,367:152-157.
doi: 10.1016/j.jns.2016.06.004 URL pmid: 27423581 |
[16] |
Inamdar P, Masavkar S, Shanbag P . Hyponatremia in children with tuberculous meningitis: A hospital-based cohort study. J Pediatr Neurosci, 2016,11(3):182-187.
doi: 10.4103/1817-1745.193376 URL pmid: 27857783 |
[17] | 万洪光, 陈悦 . 结核性脑膜炎并低钠血症36例临床分析. 中国实用乡村医生杂志, 2013,20(6):60-61. |
[18] | 廖琼, 邓建军, 邓思燕 , 等. 儿童结核性脑膜炎近期预后的影响因素. 中国当代儿科杂志, 2012,14(5):328-331. |
[19] |
Modi M, Sharma K, Prabhakar S , et al. Clinical and radiological predictors of outcome in tubercular meningitis: A prospective study of 209 patients. Clin Neurol Neurosurg, 2017,161:29-34.
doi: 10.1016/j.clineuro.2017.08.006 URL pmid: 28843114 |
[20] |
Duque-Silva A, Hampole V, Cheng YN , et al. Outcomes of Pediatric Central Nervous System Tuberculosis in California, 1993—2011. J Pediatric Infect Dis Soc, 2018.
doi: 10.1093/jpids/piz079 URL pmid: 31782958 |
[21] |
Soria J, Metcalf T, Mori N , et al. Mortality in hospitalized patients with tuberculous meningitis. BMC Infect Dis, 2019,19(1):9.
doi: 10.1186/s12879-018-3633-4 URL pmid: 30611205 |
[22] |
More A, Verma R, Garg RK , et al. A study of neuroendocrine dysfunction in patients of tuberculous meningitis. J Neurol Sci, 2017,15(379):198-206.
doi: 10.1016/j.jns.2017.06.015 URL pmid: 28716240 |
[23] | 黄威, 安雪梅, 刘旭晖 , 等. 164例结核性脑膜炎患者预后影响因素分析. 中国防痨杂志, 2019,41(6):632-639. |
[24] |
Wasay M, Farooq S, Khowaja ZA , et al. Cerebral infarction and tuberculoma in central nervous system tuberculosis: frequency and prognostic implications. J Neurol Neurosurg Psychiatry, 2014,85(11):1260-1264.
doi: 10.1136/jnnp-2013-307178 URL pmid: 24623792 |
[25] |
Chaudhary V, Bano S, Garga UC . Central Nervous System Tuberculosis: An Imaging Perspective. Can Assoc Radiol J, 2017,68(2):161-170.
doi: 10.1016/j.carj.2016.10.007 URL pmid: 28283299 |
[26] | Azeemuddin M, Alvi A, Sayani R , et al. Neuroimaging Findings in Tuberculosis: A Single-Center Experience in 559 Cases. J Neuroimaging, 2019. In press. |
[27] |
Faried A, Arief G, Arifin MZ , et al. Correlation of Lactate Concentration in Peripheral Plasma and Cerebrospinal Fluid with Glasgow Outcome Scale for Patients with Tuberculous Meningitis Complicated by Acute Hydrocephalus Treated with Fluid Diversions. World Neurosurg, 2018,111:e178-182.
doi: 10.1016/j.wneu.2017.12.007 URL pmid: 29248780 |
[28] |
Cantier M, Morisot A, Guérot E , et al. Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study. Crit Care, 2018,22(1):210.
doi: 10.1186/s13054-018-2140-8 URL pmid: 30119686 |
[29] |
Merkler AE, Reynolds AS, Gialdini G , et al. Neurological complications after tuberculous meningitis in a multi-state cohort in the United States. J Neurol Sci, 2017,375:460-463.
doi: 10.1016/j.jns.2017.02.051 URL pmid: 28320186 |
[30] |
Sharma D, Shah I, Patel S . Late onset hydrocephalus in children with tuberculous meningitis. J Family Med Prim Care, 2016,5(4):873-874.
doi: 10.4103/2249-4863.201145 URL pmid: 28349011 |
[31] |
Aranha A, Choudhary A, Bhaskar S , et al. A Randomized Study Comparing Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in the Management of Hydrocephalus Due to Tuberculous Meningitis. Asian J Neurosurg, 2018,13(4):1140-1147.
doi: 10.4103/ajns.AJNS_107_18 URL pmid: 30459883 |
[32] |
Neyrolles O, Quintana-Murci L . Sexual inequality in tuberculosis. PLoS Med, 2009,6(12):e1000199.
doi: 10.1371/journal.pmed.1000199 URL pmid: 20027210 |
[33] |
Yen YF, Hu HY, Lee YL , et al. Sexual inequality in incident tuberculosis: a cohort study in Taiwan. BMJ Open, 2018,8(2):e020142.
doi: 10.1136/bmjopen-2017-020142 URL pmid: 29437757 |
[1] | 陈娟, 毛毅, 陈洪德. 30例危重症肺结核孕产妇的临床特征及预后分析[J]. 中国防痨杂志, 2020, 42(6): 638-640. |
[2] | 秦楠,徐春泽,关颖,路丽苹,王伟炳,姜永根. 上海市松江城区结核病登记死亡患者特征及影响因素分析[J]. 中国防痨杂志, 2020, 42(4): 345-352. |
[3] | 尤媛媛,张国龙,陈裕. 120例初治耐多药肺结核患者治疗依从性的影响因素分析[J]. 中国防痨杂志, 2020, 42(3): 249-254. |
[4] | 马进宝, 马婷婷, 任斐, 杨翰, 谭淦纹. 涂阳肺结核患者γ-干扰素释放试验假阴性的影响因素分析[J]. 中国防痨杂志, 2020, 42(12): 1299-1304. |
[5] | 吕和, 王政, 王婷, 闫雅更, 董凤丽, 杨晓巍, 张琳, 郭晓微, 王红梅, 徐欢. 非活动性肺结核并发慢性阻塞性肺疾病患者营养状况及营养风险分析[J]. 中国防痨杂志, 2020, 42(12): 1310-1312. |
[6] | 杨汝铃, 龙晓茹, 张祯祯, 郑改焕, 赵瑞秋, 许红梅. 222例儿童结核性脑膜炎的临床特征及其预后影响因素分析[J]. 中国防痨杂志, 2020, 42(10): 1053-1060. |
[7] | 高颖,王琳,陈丽娜. 颈部淋巴结结核自然破溃和淋巴结切开术后伤口愈合时间的影响因素分析[J]. 中国防痨杂志, 2019, 41(8): 857-862. |
[8] | 杜建,韩喜琴,舒薇,陈梓,谢仕恒,吕晓亚,戈启萍,马艳,刘宇红,李亮,高微微. 复治菌阳肺结核患者治疗成功后再次复发的危险因素分析[J]. 中国防痨杂志, 2019, 41(6): 624-631. |
[9] | 黄威,安雪梅,刘旭晖,裴宁,刘萍,夏露,李涛,席秀红,黄琴,卢水华. 164例结核性脑膜炎患者预后影响因素分析[J]. 中国防痨杂志, 2019, 41(6): 632-639. |
[10] | 李文婷,陈红霞,杨妍. 溃疡坏死型支气管结核不良转归的影响因素分析[J]. 中国防痨杂志, 2019, 41(6): 640-644. |
[11] | 李凌海,于大青,王春,刘涛,史志国. 脊柱结核患者术中出现低体温的危险因素研究[J]. 中国防痨杂志, 2019, 41(4): 426-429. |
[12] | 许金红,杨松,张立新,钟颖,邱倩. 中国耐多药结核病发病危险因素的Meta分析[J]. 中国防痨杂志, 2019, 41(12): 1301-1309. |
[13] | 吴桂辉,黄涛,程耀,黄晓秋,傅小燕,马瑶,李鹏,何畏. HIV感染并发结核性脑膜炎患者的临床特征及其预后影响因素分析[J]. 中国防痨杂志, 2019, 41(1): 18-23. |
[14] | 李雪莲,李洁,陈红梅,刘荣梅,马丽萍,张立群,高孟秋. 结核性脑膜炎并发颅神经损伤的临床特征分析[J]. 中国防痨杂志, 2019, 41(1): 24-30. |
[15] | 姚琳,席向宇,王霞芳,沈兴华,张建平,叶志坚,施美华,吴妹英,唐佩军. HIV阴性结核性脑膜炎患者预后影响因素分析[J]. 中国防痨杂志, 2019, 41(1): 31-35. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||