Analysis of prognostic factors in 164 tuberculous meningitis patients

doi:10.3969/j.issn.1000-6621.2019.06.008

Abstract

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

Wei HUANG,Xue-mei AN,Xu-hui LIU,Ning PEI,Ping LIU,Lu XIA,Tao LI,Xiu-hong XI,Qin HUANG,Shui-hua LU. Analysis of prognostic factors in 164 tuberculous meningitis patients[J]. Chinese Journal of Antituberculosis, 2019, 41(6): 632-639. doi: 10.3969/j.issn.1000-6621.2019.06.008

Figures/Tables 3

人口学(临床)特征	合计(164例)	预后良好组(95例)	预后不良组(69例)	统计检验值	P值
年龄(岁)				χ²=7.06	0.008
0~	42(25.6)	17(17.9)	25(36.2)
>15	122(74.4)	78(82.1)	44(63.8)
性别				χ²=0.24	0.624
男	101(61.6)	57(60.0)	44(63.8)
女	63(38.4)	38(40.0)	25(36.2)
卡介苗接种				$χ 校正 2$ =0.30	0.581
是	153(93.3)	90(94.7)	63(91.3)
否	11(6.7)	5(5.3)	6(8.7)
MRC级别				χ²=25.02	0.000
Ⅰ或Ⅱ级	105(64.0)	76(80.0)	29(42.0)
Ⅲ级	59(36.0)	19(20.0)	40(58.0)
临床症状
发热	127(77.4)	77(81.1)	50(72.5)	χ²=1.69	0.194
脑膜刺激症	105(64.0)	65(68.4)	40(58.0)	χ²=1.90	0.169
人口学(临床)特征	合计(164例)	预后良好组(95例)	预后不良组(69例)	统计检验值	P值
就诊时诊断				χ²=1.36	0.508
确诊	47(28.6)	28(29.4)	19(27.6)
高度疑似	80(48.8)	43(45.3)	37(53.6)
疑似	37(22.6)	24(25.3)	13(18.8)
脑脊液检查[M(Q₁,Q₃)]
白细胞计数(×10⁶/L)^a	154.5(71.0,307.5)	156.0(80.0,300.0)	153.0(47.5,335.0)	Z=-0.03	0.979
葡萄糖(mmol/L)^b	1.9(1.3,2.6)	2.0(1.4,2.7)	1.7(1.2,2.6)	Z=-0.82	0.410
蛋白质(g/L)^b	1.7(1.0,2.6)	1.6(1.0,2.4)	1.8(1.1,3.1)	Z=-1.30	0.195
头颅CT或MRI(纳入例数)^c	155	93	62
脑积液	45(29.0)	11(11.8)	34(54.8)	χ²=33.40	0.000
脑梗死	32(20.6)	4(4.3)	28(45.2)	χ²=37.91	0.000
脑脓肿或结核瘤	53(34.2)	35(37.6)	18(29.0)	χ²=1.22	0.269
脑膜强化	58(37.4)	36(38.7)	22(35.5)	χ²=0.17	0.684
胸部CT(纳入例数)^c	155	91	64
异常	113(72.9)	64(70.3)	49(76.6)	χ²=0.74	0.390
无异常	42(27.1)	27(29.7)	15(23.4)
双肺粟粒状影	41(26.5)	24(26.4)	17(26.6)	χ²=0.001	0.979
无粟粒状影	114(73.5)	67(73.6)	47(73.4)
机械通气(纳入例数)^d	159	92	67	χ²=7.53	0.006
有	18(11.3)	5(5.4)	13(19.4)
无	141(88.7)	87(94.6)	54(80.6)
T-SPOT.TB(纳入例数)^e	113	47	66	χ²=0.43	0.511
阳性	83(73.5)	33(70.2)	50(75.8)
阴性	30(26.5)	14(29.8)	16(24.2)
异烟肼耐药(纳入例数)^f	30	19	11	-	0.104
是	8(26.7)	3(15.8)	5(45.5)
否	22(73.3)	16(84.2)	6(54.5)
利奈唑胺是否运用				χ²=7.69	0.006
是	79(48.2)	37(38.9)	42(60.9)
否	85(51.8)	58(61.1)	27(39.1)
利奈唑胺应用时间				χ²=4.58	0.032
2周内使用	26(15.9)	20(21.1)	6(8.7)
2周内未用	138(84.1)	75(78.9)	63(91.3)

人口学(临床)特征	2周内使用(26例)	2周内未用(53例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	27(9.8,45.8)	19(2.0,31.5)	Z=-1.62	0.106
TBM严重程度			χ²=1.08	0.300
MRC Ⅰ或Ⅱ级	11(42.3)	29(54.7)
MRC Ⅲ级	15(57.7)	24(45.3)
临床症状
发热	19(73.1)	41(77.4)	χ²=0.18	0.676
脑膜刺激征	18(69.2)	31(58.5)	χ²=0.85	0.355
脑脊液检查[M(Q₁,Q₃)]
白细胞计数(×10⁶/L)^a	220.0(60.0,328.5)	153.0(80.0,287.5)	Z=-0.31	0.755
葡萄糖(mmol/L)^b	1.9(1.1,2.4)	1.7(1.1,2.6)	Z=-0.03	0.977
蛋白质(g/L)^b	1.7(1.0,2.9)	1.7(0.8,3.0)	Z=-0.09	0.928
头颅MR或CT^c(纳入例数)	24	48
脑梗死	3(12.5)	14(29.2)	χ²=2.46	0.116
脑积液	6(25.0)	19(39.6)	χ²=1.50	0.220
胸部CT^d(纳入例数)	25	50
粟粒状影	9(36.0)	18(36.0)	χ²=0.00	1.000
异常	19(76.0)	43(86.0)	$χ 校正 2$ =0.57	0.450
机械通气^e(纳入例数)	26	49
是	4(15.4)	9(18.4)	$χ 校正 2$ =0.00	0.997
异烟肼耐药^f(纳入例数)	6	9
是	1(16.7)	2(22.2)	-	1.000

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
0~15岁	1.25	0.59	4.46	0.035	3.51(1.09~11.22)
MRC Ⅲ级	1.38	0.57	5.82	0.016	3.95(1.29~12.09)
发生脑梗死	3.25	0.68	22.82	0.000	25.90(6.81~98.40)
发生脑积液	2.30	0.53	19.13	0.000	10.00(3.56~28.07)
有机械通气	1.02	0.83	1.52	0.218	2.77(0.55~14.08)
2周内应用利奈唑胺	-1.97	0.77	6.48	0.011	0.14(0.03~0.64)
常量	-2.50	0.43	33.40	0.000	-

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