Chinese Journal of Antituberculosis ›› 2018, Vol. 40 ›› Issue (9): 932-939.doi: 10.3969/j.issn.1000-6621.2018.09.005
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Tong-qiang ZHANG1,Lin SUN2,Wei GUO1,Cai-li ZHOU1,Li-xin REN1,Zhuo FU1,Shu-jing LI1,A-dong SHEN2,(),Yong-sheng XU1,()
Received:
2018-07-02
Online:
2018-09-10
Published:
2018-10-17
Contact:
A-dong SHEN,Yong-sheng XU
E-mail:shenad16@hotmail.com;drxu69@gmail.com
Tong-qiang ZHANG,Lin SUN,Wei GUO,Cai-li ZHOU,Li-xin REN,Zhuo FU,Shu-jing LI,A-dong SHEN,Yong-sheng XU. The evaluation of tuberculous meningitis scoring system in the diagnose of tuberculous meningitis in children[J]. Chinese Journal of Antituberculosis, 2018, 40(9): 932-939. doi: 10.3969/j.issn.1000-6621.2018.09.005
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URL: http://www.zgflzz.cn/EN/10.3969/j.issn.1000-6621.2018.09.005
分类 | 评分指标 | 得分 |
---|---|---|
临床标准(最高6分) | 症状超过5d | 4 |
提示存在结核全身中毒症状(1个及多个):体质量减轻或者不增长;盗汗、持续咳嗽>2周 | 2 | |
近1年内有与肺结核患者密切接触史或者TST或(和)IGRA阳性者(仅限于<10岁儿童) | 2 | |
神经系统检查有局灶性神经系统缺失症状与体征表现(除外脑神经麻痹) | 1 | |
脑神经麻痹 | 1 | |
意识改变 | 1 | |
脑脊液标准(最高4分) | 清亮 | 1 |
白细胞计数(10~500)×106 个/L | 1 | |
淋巴细胞比例(>0.50) | 1 | |
蛋白浓度>1g/L | 1 | |
脑脊液葡萄糖/血葡萄糖浓度<0.5,或脑脊液葡萄糖浓度<2.2mmol/L | 1 | |
头颅影像学表现(最高6分) | 脑积水 | 1 |
基底脑膜强化 | 2 | |
结核瘤 | 2 | |
脑梗死 | 1 | |
强化前基底部高密度影 | 2 | |
其他部位结核感染的证据 | 胸片有活动性肺结核的表现:肺结核=2,粟粒型肺结核=4 | 2/4 |
(最高4分) | 神经系统外CT/MRI/B型超声检查发现有结核病表现 | 2 |
从痰、淋巴结、胃液、尿液、血等培养出MTB或者抗酸杆菌染色阳性 | 4 | |
从神经系统外标本中检测到MTB核酸b | 4 |
TBM评分系统参数 | TBM组 (102例) | 比率 (%) | 病毒性脑炎 组(125例) | 比率 (%) | χ2值 | P值 |
---|---|---|---|---|---|---|
临床标准 | ||||||
症状超过5d | 95 | 93.14 | 43 | 34.40 | 81.30 | <0.001 |
结核全身中毒症状 | 48 | 47.06 | 2 | 1.60 | 67.58 | <0.001 |
结核病接触史 | 21 | 20.59 | 2 | 1.60 | 17.82 | <0.001 |
TST阳性 | 51 | 50.00 | 1 | 0.80 | 76.99 | <0.001 |
IGRA | 74 | 72.55 | 1 | 0.80 | 130.79 | <0.001 |
神经系统局灶缺失表现 | 11 | 10.78 | 1 | 0.80 | 11.18 | 0.001 |
脑神经麻痹 | 24 | 23.53 | 1 | 0.80 | 26.61 | <0.001 |
意识改变 | 58 | 56.86 | 30 | 24.00 | 25.55 | <0.001 |
脑脊液标准 | ||||||
清亮 | 98 | 96.08 | 125 | 100.00 | 4.99 | 0.025 |
白细胞数(10~500)×106个/L | 94 | 92.16 | 77 | 61.60 | 28.22 | <0.001 |
淋巴细胞比例(>50%) | 90 | 88.24 | 96a | 88.89 | 0.02 | 0.882 |
蛋白浓度>1.0g/L | 76 | 74.51 | 0 | 0.00 | 140.01 | <0.001 |
脑脊液葡萄糖/血葡萄糖浓度<0.5,或脑脊液葡萄糖浓度<2.2mmol/L | 85 | 83.33 | 2 | 1.60 | 158.74 | <0.001 |
脑影像学表现 | ||||||
脑积水 | 41 | 40.20 | 1 | 0.80 | 57.81 | <0.001 |
基底脑膜强化 | 78 | 76.47 | 7 | 5.60 | 120.44 | <0.001 |
结核瘤 | 11 | 10.78 | 0 | 0.00 | 14.17 | <0.001 |
脑梗死 | 7 | 6.86 | 0 | 0.00 | 8.85 | 0.003 |
强化前基底高密度 | 4 | 3.92 | 0 | 0.00 | 4.99 | 0.025 |
肺结核或肺外结核的其他表现 | ||||||
肺结核 | 48 | 47.06 | 0 | 0.00 | 74.60 | <0.001 |
粟粒型肺结核 | 24 | 23.53 | 0 | 0.00 | 32.89 | <0.001 |
神经系统外CT/MR/B型超发现有结核病表现 | 11 | 10.78 | 0 | 0.00 | 11.92 | 0.001 |
其他部位标本抗酸杆菌染色阳性或(和)培养出MTB | 15 | 14.71 | 0 | 0.00 | 19.78 | <0.001 |
神经系统外标本中检测到MTB核酸 | 21 | 20.59 | 2 | 1.60 | 20.18 | <0.001 |
诊断方法 | TBM组(例) | 病毒性脑炎组(例) | 敏感度 (%) | χ2值a | P值a | 特异度 (%) | χ2值b | P值b | ||
---|---|---|---|---|---|---|---|---|---|---|
阳性 | 阴性 | 阳性 | 阴性 | |||||||
TBM评分系统 | 92 | 10 | 0 | 125 | 90.20 | 100.00 | ||||
脑脊液DNA | 14 | 71 | 4 | 106 | 16.47 | 100.64 | <0.001 | 96.36 | 0.67 | 0.415 |
脑脊液MTB培养 | 11 | 91 | 0 | 125 | 10.78 | 128.66 | <0.001 | 100.00 | - | - |
脑脊液抗酸染色 | 16 | 86 | 2 | 123 | 15.69 | 113.65 | <0.001 | 98.40 | 0.50 | 0.478 |
TST | 51 | 51 | 1 | 124 | 50.00 | 39.31 | <0.001 | 99.20 | 0.00 | 1.000 |
IGRA | 74 | 28 | 1 | 124 | 72.55 | 10.48 | 0.001 | 99.20 | 0.00 | 1.000 |
基底脑膜强化 | 78 | 24 | 7 | 118 | 76.47 | 6.92 | 0.009 | 94.40 | 5.29 | 0.021 |
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