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目的讨论急性粟粒型肺结核合并结核性脑膜脑炎的临床特点。方法回顾性分析2例急性粟粒型肺结核合并结核性脑膜脑炎患者的临床资料。结果本组患者为2例青年男性,分别为27、28岁,既往均无慢性结核感染的病史。2例患者临床表现主要为急性起病,高热、头痛,迅速出现严重的意识障碍,同时合并中枢神经系统实质受损。脑脊液检查呈细胞数、蛋白增高,显著低糖低氯化物的典型结核改变,胸部CT为双肺弥漫的大小、密度、分布均匀异常密度影,头部CT早期出现明显脑积水、细胞间质性水肿。临床诊断急性粟粒型肺结核合并结核性脑膜脑炎,抗结核治疗有效,但遗留了严重的神经系统后遗症。结论急性粟粒型肺结核血行感染中枢神经系统导致的结核性脑膜脑炎起病迅速,感染中毒症状极重,伴有中枢神经系统实质性损害,结核抗酸杆菌病原学检出率明显高于经典的结核性中枢神经系统感染,预后凶险。
Objective To discuss the clinical features of acute miliary tuberculosis combined with tuberculous meningoencephalitis. Methods The clinical data of 2 patients with acute miliary tuberculosis combined with tuberculous meningoencephalitis were retrospectively analyzed. Results The patients in this study were 2 young men, 27 and 28 years old, respectively. None of them had a history of chronic tuberculosis infection. The clinical manifestations of 2 patients were mainly acute onset, fever, headache, rapid serious disturbance of consciousness, and complicated central nervous system degeneration. Cerebrospinal fluid showed cell number, protein increased, the typical tuberculosis of hypoglycemic hypoglycemic changes significantly, chest CT of diffuse lung size, density, density distribution of abnormal density, head CT obvious early hydrocephalus, interstitial Edema. Clinical diagnosis of acute miliary tuberculosis combined with tuberculous meningoencephalitis, anti-TB treatment effective, but left a serious nervous system sequelae. Conclusions Acute miliary tuberculosis infection in the central nervous system leads to rapid onset of tuberculous meningoencephalitis, severe symptoms of poisoning and severe damage to the central nervous system. The detection rate of acid-fast bacilli is significantly higher than that of the classic Tuberculosis of the central nervous system infection, the prognosis is dangerous.