儿童结核性脑膜炎近期预后的影响因素

Factors influencing short-term prognosis of tuberculous meningitis in children

摘要:

目的：探讨影响儿童结核性脑膜炎（TBM）近期预后的因素。方法：采用回顾性病例分析的方法，收集2007年1月至2011年2月137 例住院治疗的TBM患儿的临床资料，对30个可能影响近期预后的因素进行了单因素及多因素logistic回归分析。结果：137例TBM患儿中，临床分期为早、中、晚期病例分别为21例（15.3%）、67例（48.9%）、49例（35.8%）。单因素分析显示TBM的临床分期为晚期、昏迷、Babinski征阳性、颅神经损害、肢体瘫痪、抽搐、头颅CT或MRI明显异常、脑脊液蛋白量升高等因素与近期预后不良有关；而糖皮质激素的使用、PPD皮试反应阳性、住院时间延长与预后良好有关。多因素分析显示：临床分期为晚期（OR=11.168,95%CI 3.521~35.426）和脑膜刺激征阳性（OR=4.275, 95%CI 1.043~17.521）是影响TBM近期预后的危险因素，而住院时间延长（OR=0.893, 95%CI 0.825~0.968）是影响近期预后的保护因素。结论：TBM患儿出现脑膜刺激征及临床分期越晚提示预后不良，适当的延长住院时间有利于改善近期预后。

Abstract:

OBJECTIVE: To study the factors influencing short-term prognosis of tuberculous meningitis (TBM) in children. METHODS: The clinical data of 137 hospitalized children with TBM between January 2007 and February 2011 were retrospectively reviewed. A total of 30 potential factors influencing short-term prognosis of TBM were evaluated by univariate analysis and multivariate logistic regression analysis. RESULTS: Clinical staging showed that of the 137 children 21 cases (15.3%) were in the early stage, 67 cases (48.9%) in the medium stage and 49 cases (35.8%) in the late stage of TBM. The univariate analysis revealed 8 factors associated with a poor short-term prognosis: clinical stage of TBM (late), coma, positive Babinski signs, cranial nerve involvements, paralysis, seizures, obvious abnormalities in brain computed tomography (CT) or magnetic resonance imaging (MRI) and elevated protein concentrations in cerebrospinal fluid (CSF). Factors associated with a favourable short-term prognosis for TBM included glucocorticoid steroids therapy, positive reaction of PPD skin test and an increased length of stay in hospital. Multivariate logistic analysis revealed two independent risk factors for a poor short-term prognosis: clinical stage of TBM (late) (OR: 11.168, 95%CI: 3.521-35.426) and positive signs of meningeal irritation (OR: 4.275, 95%CI: 1.043-17.521). An increased length of stay in hospital was shown as a favorable factor (OR: 0.893, 95%CI: 0.825-0.968). CONCLUSIONS: Late-stage TBM and positive signs of meningeal irritation suggest a poor prognosis, while an appropriately longer length of stay in hospital may contribute to a favorable short-term prognosis for children with TBM.