Guidelines for the diagnosis and treatment of adult tuberculous meningitis (2026 edition)

doi:10.19982/j.issn.1000-6621.20260279

Abstract

Abstract:

Tuberculous meningitis is the most severe form of tuberculosis, in addition to being the most difficult to diagnose. It is prone to delayed diagnosis and treatment, which negatively influence the prognosis of patients. The Clinical Tuberculosis Branch of the Chinese Antituberculosis Association, Beijing Chest Hospital, Capital Medical University, Jiangxi Chest Hospital and Changchun Infectious Disease Hospital, drawing on relevant domestic and international guidelines and supplementing them with new research evidence, combined with the clinical practice of tuberculous meningitis diagnosis and treatment in China, have developed the guidelines for the diagnosis and treatment of adult tuberculous meningitis (2026 edition). The guideline systematically summarizes the recommendations for diagnostic methods for tuberculous meningitis, updates the recommendations for treatment regimens, and provides recommendations for the management of tuberculous meningitis under special circumstances, offering evidence-based clinical practice guidance for further improving and optimizing the management of tuberculous meningitis in national and regional medical institutions.

Key words: Tuberculosis, meninges, Diagnosis, Treatment, Guideline

CLC Number:

R529.3

Clinical Tuberculosis Branch of the Chinese Antituberculosis Association, Beijing Chest Hospital, Capital Medical University, Jiangxi Chest Hospital, Changchun Infectious Disease Hospital. Guidelines for the diagnosis and treatment of adult tuberculous meningitis (2026 edition)[J]. Chinese Journal of Antituberculosis, 2026, 48(10): 1457-1470. doi: 10.19982/j.issn.1000-6621.20260279

Figures/Tables 9

References 86

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证据质量分级	具体描述
高	对观察值非常有把握;观察值接近真实值
中	对观察值有中等程度的把握;观察值有可能接近真实值
低	对观察值的把握有限;观察值可能与真实值有很大区别
极低	对观察值几乎无把握;观察值可能与真实值有极大区别

推荐强度分级	具体描述
强烈推荐	明确显示所推荐的干预措施利大于弊或弊大于利
有条件推荐	已有证据显示利弊不确定或无论质量高低的证据显示利弊相当

指标	发生率或检查结果
症状
头痛	50%~80%
发热	60%~95%
呕吐	30%~60%
畏光	5%~10%
食欲不振/体质量降低	60%~80%
体征
颈强直	40%~80%
意识模糊	10%~30%
昏迷	30%~60%
脑神经麻痹	30%~50%
偏瘫	10%~20%
截瘫	5%~10%
癫痫	5%
脑脊液检查
外观清亮	80%~90%
颅压>250mmH₂O	50%
白细胞计数(×10⁶个/L)	10~1000
蛋白(g/L)	0.45~3.0
脑脊液糖/血糖比值<0.5	95%

标准		评分
临床标准(最高评分=6分)
结核性脑膜炎症状(发热、头痛、呕吐)持续超过5d		4
症状提示结核病(至少一项):体质量下降、盗汗或持续咳嗽超过2周		2
近期有肺结核患者密切接触史,或IGRA阳性/TST强阳性		2
局灶神经损伤(偏瘫、截瘫等)		1
脑神经麻痹		1
意识障碍		1
脑脊液标准(最高评分=4分)
外观清亮		1
细胞数:10~500个/μl		1
淋巴细胞为主(>50%)		1
蛋白含量超过1g/L		1
脑脊液与血浆葡萄糖比值低于50%或脑脊液葡萄糖浓度低于2.2mmol/L		1
颅脑影像检查标准(最高评分=6分)
脑积水(CT或MRI)	1
基底脑膜强化(CT或MRI)	2
结核球(CT或MRI)	2
脑梗死(CT或MRI)	1
增强前基底池高密度(CT)	2
其他部位的结核病证据(最高评分=4分)
胸部影像检查提示活动性肺结核(除粟粒性结核病)	2
胸部影像检查提示粟粒性结核病	4
影像或超声检查提示中枢神经系统结核外的结核病	2
其他部位发现抗酸杆菌或培养发现分枝杆菌(如痰、淋巴结、胃液、尿和血等)	4
神经系统外的标本经商业化结核分枝杆菌核酸扩增方法检测阳性	4

分级	定义
Ⅰ级	清醒、无定向力障碍,且无局部神经损伤
Ⅱ级	Glasgow昏迷指数10~14,伴或不伴局部神经损伤;或Glasgow昏迷指数15伴局部神经损伤
Ⅲ级	Glasgow昏迷指数<10伴或不伴局部神经损伤