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中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (8): 910-917.doi: 10.19982/j.issn.1000-6621.20240069

• 论著 • 上一篇    下一篇

低剂量沙利度胺辅助治疗20例成人结核性脑膜炎矛盾反应的临床分析

赵雪瑶1, 韩利军1(), 冯国栋2(), 秦桂香1, 孙力1   

  1. 1长春市传染病医院结核性脑膜炎诊断与治疗中心,长春 130000
    2复旦大学附属中山医院,上海 200032
  • 收稿日期:2024-02-26 出版日期:2024-08-10 发布日期:2024-08-01
  • 通信作者: 韩利军,冯国栋 E-mail:843556647@qq.com;feng.guodong@zs-hospital.sh.cn
  • 基金资助:
    吉林省卫生技术创新项目(2018J001)

Clinical analysis of low dose thalidomide in the adjuvant treatment of 20 cases of adult tuberculous meningitis complicated with paradoxical reactions

Zhao Xueyao1, Han Lijun1(), Feng Guodong2(), Qin Guixiang1, Sun Li1   

  1. 1Tuberculosis Meningitis Diagnosis and Treatment Center, Changchun Infectious Hospital, Changchun 130000, China
    2Zhongshan Hospital Fudan University, Shanghai 200032, China
  • Received:2024-02-26 Online:2024-08-10 Published:2024-08-01
  • Contact: Han Lijun,Feng Guodong E-mail:843556647@qq.com;feng.guodong@zs-hospital.sh.cn
  • Supported by:
    Health Technology Innovation Project of Jilin Province(2018J001)

摘要:

目的: 分析低剂量沙利度胺辅助治疗成人结核性脑膜炎(tuberculous meningitis,TBM)矛盾反应的临床疗效和安全性。方法: 选取2020年1月1日至2022年12月30日长春市传染病医院收治的符合TBM矛盾反应诊断标准的患者共20例进行回顾性研究。20例患者均在不调整原有糖皮质激素用量及抗结核治疗方案的前提下,口服沙利度胺25mg(4次/d)治疗。分析患者应用沙利度胺后临床症状转归、脑脊液参数变化、影像学表现及药物不良反应。结果: 20例患者中, 14例(70.0%)出现新发结核瘤,11例(55.0%)原有结核瘤病变恶化、10例(50.0%)脑池渗出增多,5例(25.0%)新发脑梗死。经沙利度胺治疗后,14例新发结核瘤及11例原有结核瘤恶化的患者,病灶明显好转,≤3mm的结核结节可完全吸收,>3mm的结核结节可表现为完全吸收或病灶范围缩小;10例脑池渗出增多的患者,病灶明显消退。5例脑梗死患者,无进展性卒中发生,梗死周围水肿明显消退并形成软化灶。17例脑脊液异常患者中,8例脑脊液白细胞计数恢复正常,9例脑脊液参数好转稳定。沙利度胺中位治疗时间为16(12,16)周。全部患者均在颅内病变明显好转或脑脊液指标好转稳定后,停用沙利度胺。治疗期间,2例患者出现末梢神经炎,给予营养神经治疗后好转,无其他可归因于沙利度胺的不良事件报告。结论: 低剂量沙利度胺辅助治疗结核性脑膜炎矛盾反应,可有效改善患者颅内病变及脑脊液参数,且安全性较好。

关键词: 结核,脑膜, 沙利度胺, 矛盾反应, 辅助治疗

Abstract:

Objective: To analyze the clinical effectiveness and safety of low dose thalidomide in the adjuvant treatment of tuberculous meningitis (TBM) complicated with paradoxical reactions in adults. Methods: A total of 20 patients who met the diagnostic criteria of TBM complicated with paradoxical reactions admitted to Changchun Infectious Disease Hospital from January 1, 2020 to December 30, 2022 were selected for retrospective study. Oral thalidomide (25 mg, 4 times/day) was administered without adjusting the dosage of original hormone and anti-tuberculosis therapy regimen. Clinical symptoms, cerebrospinal fluid (CSF) parameters, imaging findings and adverse drug reactions were analyzed. Results: Among the 20 patients, 14 (70.0%) had new tuberculoma, 11 (55.0%) had deterioration of original tuberculoma, 10 (50.0%) had increased cisternal effusion, and 5 (25.0%) had new cerebral infarction. After treatment with thalidomide, the lesions of 14 patients with new tuberculoma and 11 patients with deterioration of original tuberculoma improved significantly, tuberculous nodules ≤3 mm could be completely absorbed, and tuberculous nodules >3 mm could be completely absorbed or the lesions shrank. In 10 patients with increased cisternal exudation, the lesions subsided significantly. In 5 patients with cerebral infarction, no progressive stroke occurred, and the edema around the infarction significantly subsided to a softening lesion. Of the 17 patients with abnormal CSF, 8 had their CSF white blood cell counts recovered to normal, and 9 had CSF parameters improved and stabilized. The median treatment time of thalidomide was 16 (12,16) weeks. All patients stopped thalidomide after intracranial lesions got improved significantly or CSF parameters improved and stabilized. During treatment, 2 patients developed peripheral neuritis which improved after receiving nutritional neurotherapy, and no other adverse events attributable to thalidomide were reported. Conclusion: Low dose thalidomide adjuvant treatment on tuberculous meningitis paradoxical reaction can effectively improve intracranial lesions and CSF parameters of patients, with good safety.

Key words: Tuberculosis, meningeal, Thalidomide, Contradictory reaction, Treatment

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