作　　者： (黄麦玲）; (马艳）; (陈红梅）; (刘荣梅）; (宋艳华）; (谢莉）; (吴晓光）; (马丽萍）; (高孟秋）; (李琦）;

机构地区： 首都医科大学附属北京胸科医院结核二病区,101149

出　　处： 《中国防痨杂志》 2017年第8期883-889,共7页

摘　　要： 目的探讨老年结核性脑膜炎（TBM）临床特征。方法搜集2011年1月至2017年1月在首都医科大学附属北京胸科医院住院的44例老年TBM患者（年龄）65岁），对其临床资料进行回顾性分析。结果44例患者中，男22例，女22例；中位年龄72．5岁。根据结核性脑膜炎临床诊断标准，确诊TBM3例、可能TBM41例。发病中位时间20d，63．6％（28／44）患者就诊时为TBMⅡ、Ⅲ期。临床表现以发热（40／44，90．9％）、头痛（27／44，61．4％）、消瘦（23／44，52．3％）、意识障碍（16／44，36．4％）、呕吐（16／44，36．4％）、脑膜刺激征（15／44，34．1％）为主。仅7例（7／44，15．9％）患者颅内压〉200mmH2O（1mmH2O=0．00978kPa）。44例患者脑脊液白细胞均增高，以单核细胞为主；蛋白增高均较为明显，但糖及氯化物降低不明显。32．6％（14／43）患者腺苷脱氨酶）10U／L。26例患者行头颅MRI增强检查，88．5％（23／26）有TBM征象，主要以结核结节与结核瘤最常见，其次为基底池、侧裂池、软脑膜增厚。8例患者行头颅CT增强扫描，均无明确的TBM征象发现。67．6％（23／34）患者并发脑梗塞。所有患者均并发颅外结核，以血行播散性肺结核（23例）、继发性肺结核（15例）、结核性胸膜炎（8例）、胸椎结核（6例）常见。36例患者并发其他慢性疾病。26例初诊时被误诊为其他疾病，误诊率达59．1％（26／44）。2例患者未接受抗结核治疗。42例患者接受抗结核药物治疗，其中30例（30／42，71．4％）患者好转；5例（5／42，11．9％）患者死亡，5例（5／42，11．9％）患者放弃继续治疗，2例（2／42，4．8％）患者治疗后无好转。结论老年TBM患者多表现为亚急性、慢性病程，并发颅外结核病及慢性病多见，临床表现多样化，脑脊液实验室检查不典型，头颅影像学检查无特异性，误诊率高，预� Objective To explore the clinical characteristics of tuberculous meningitis in the elderly. Methods The clinical data collected in 44 elderly patients with TBM （age more than 65 years old） admitted in Beijing Chest Hospital, Capital Medical University were analyzed retrospectively during Jan. 2011 to Jan. 2017. Results Of 44 cases with TBM, males and females were half and hall The median age was 72.5 years old. Three cases were diagnosed definitely and the others were diagnosed probably according to the clinical diagnosis criteria for TBM. The median time to onset was 20 d, and 63.6% （28/44） patients were at the stage Ⅱ or Ⅲ when visiting to hospital. The main clinical manifestations were fever （40/44, 90. 9%）, headache （27/44, 61.4%）, emaciation （23/44, 52.30//00）, disturbance of consciousness （16/44,36.4%）, vomiting （16/44, 36.4%）, and meningeal irrit tion （15/44,34. 1%）. The intracranial pressures in only 7 cases were more than 200 mm H2O （1 mm H2O equal to 0. 009 78 kPa）. The leukocyte （mainly monocytes） and protein in cerebrospinal fluid （CSF） were increased obviously, but the glucose and chloride in CSF were not decreased obviously. The adenosine deaminase （ADA） levels in CSF were more than 10 U/L in 14 patients with TBM （14/43,32. 6 % ）. Twenty-six patients underwent contrastenhanced MRI examination, 88.5% （23/26） cases showed TBM features with mainly the tubercle and tuberculoma and followed by basal cistern, lateral fissure cistern, pia mater thickening. However, no TBM features were found in 8 TBM patients underwent contrast-enhanced CT examination. 67.6~ （23/34） TBM patients were complicated with cerebral infarction. All patients were complicated with extra-cranial tuberculosis including hematogenous disseminated pulmonary tuberculosis （23 cases）, postprimary pulmonary tuberculosis （15 cases）, tuberculous pleu- risy （8 cases） and thoracic vertebrae tuberculosis （6 cases）. Thirty-six patients were complicated with other chro

关 键 词： 结核 脑膜 老年人 诊断 鉴别 治疗结果 结果与过程评价 卫生保健