45例成人结核性脑膜炎早期临床分析.docVIP

45例成人结核性脑膜炎早期临床分析 杨友高 （重庆市黔江民族医院神经内科，黔江：409000） 【摘要】目的 通过分析45例成人结核性脑膜炎(TBM)病程早期临床表现，总结TBM病程早期临床症状及辅检特点，为及时、正确诊断TBM提供思路。方法 回顾性分析45例TBM患者病程早期临床症状、脑脊液（CSF）压力、常规、生化、培养、抗酸染色及颅脑CT、MRI、肺部CT。结果 TBM早期症状分散，脑脊液测压、细胞学及生化检查、增强MRI异常率较高，对TBM早期诊断价值较大。肺部CT可以为结核性脑膜炎寻找佐证。结论 TBM早期表现多样，典型脑脊液改变、典型头颅CT改变比例不高，虽增强MRI阳性率高，但不是诊断金标准，且多因素制约临床实施，早期诊断TBM要综合分析判断，对高度怀疑TBM病例，可早期诊断性抗结核治疗，才是诊断结核性脑膜炎的关键。 【关键词】结核性脑膜炎；早期；临床分析 Early Clinical Analysis of the Tuberculous Meningitis in 45 Adult Patients Yang Yougao (Add.: The Neurology Department of Qianjiang National Hospital, Chongqing; Postcode: 409000) 【Abstract】 Objective Through analyzing the early clinical manifestations of the tuberculous meningitis (TBM) course in 45 adult patients, to summarize the early clinical symptoms and the associated test features of the TBM course and to offer a method on diagnosing the TBM timely and correctly. Methods Analyze retrospectively in 45 patients about the early clinical symptoms of the TMB disease course, the pressure of the cerebrospinal fluid (CSF), the routine, biochemical, training tests of the acid-fast stain, the Craniocerebral CT, the MRI and the lung CT. Results The early symptoms of TBM are scattered. The measuring of the CSF pressure, the test of the cytology and biochemistry, and the enhancing of the MRI all show a higher abnormal rate. This is very valued to the TBM early diagnosis. The lung CT could evidence for the TBM. Conclusion The early manifestations of the TBM are various. The change proportions of the typical CSF and the typical cerebrospinal CT is not high. Although the positive rate by enhancing the MRI is high, it’s not regard as the golden diagnosis standard. Besides, many other factors also effect the clinical implementations. To make an early diagnosis on the TBM should analyze synthetically. To those highly suspected cases on the TBM, the early diagnostic anti-tubercular treatment is the key of diagnosing the TBM. 【Key words】 The tuberculou