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结核性脑膜炎是由结核杆菌引起的中枢感染性疾病,是肺外结核病中最严重的一种,其多侵袭脑膜,有时可累及脑实质、脊髓,有很高的致死率。结核病在发展中国家中的感染趋势尤为突出。我国为人口大国,抗结核治疗和预防的形势异常严峻。随着抗结核药物的广泛使用,耐药性结核性脑膜炎患者数量增加,严重影响了结核性脑膜炎的预后。在耐药性结核性脑膜炎患者的治疗中,早期诊断、经验性治疗、调整治疗方案对患者的预后尤为重要。本文对耐药性结核性脑膜炎的分布、临床诊断、基因检测、治疗方案及预后进行系统性的总结。
Tuberculous meningitis is a central infectious disease caused by Mycobacterium tuberculosis, which is the most serious form of extrapulmonary tuberculosis. Its invasion of the meninges often affects the parenchyma of the brain and the spinal cord and has a high lethality. The trend of tuberculosis infection in developing countries is particularly prominent. My country is a populous country, and the situation of anti-TB treatment and prevention is extremely serious. With the widespread use of anti-TB drugs, the number of patients with drug-resistant tuberculous meningitis has increased, seriously affecting the prognosis of tuberculous meningitis. In the treatment of patients with drug-resistant tuberculous meningitis, early diagnosis, empirical treatment, adjustment of treatment options is particularly important for the prognosis of patients. This article systematically summarizes the distribution of drug-resistant tuberculous meningitis, clinical diagnosis, genetic testing, treatment options and prognosis.