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目的探讨结核性脑膜炎早期诊断影响因素,采取相应对策以提高对结核性脑膜炎的早期诊治率。方法选择2010年2月至2016年2月最终确诊的82例结核性脑膜炎早期患者,并选择同期检查的321例疑似结核性脑膜炎的受检者,收集所有患者的临床资料,分析影响结核性脑膜炎早期诊断的相关影响因素。结果单因素分析显示:影响结核性脑膜炎早期诊断的临床表现为头痛或颈脊痛、发热、精神异常或偏瘫发作、脑膜刺激征(P<0.05,P<0.01);影像学检查为脑内低密度改变、脑膜强化(P<0.05,P<0.01);脑脊液检查为脑脊液压、淋巴细胞比例、氯化物、糖、蛋白、腺苷脱氨酶(ADA)(P<0.05,P<0.01)。多因素Logistic分析:将单因素分析中有统计学意义的临床表现或检查指标纳入到多因素分析,结果显示,头痛或颈背痛(OR=1.840,CI:1.031~4.659,P<0.05)、发热(OR=2.437,CI:1.085~4.987,P<0.05)、脑膜刺激征(OR=2.151,CI:1.132~4.769,P<0.05)、脑膜强化(OR=1.702,CI:1.035~4.244,P<0.05)、脑脊液压力升高(OR=2.293,CI:1.182~4.868,P<0.05)、蛋白≥500 mg/L(OR=2.187,CI:1.143~4.795,P<0.05)、糖水平≥2.5 mmol/L(OR=2.835,CI:1.313~5.879,P<0.05)、氯化物水平<120 mmol/L(OR=1.665,CI:1.027~3.927,P<0.05)、ADA水平升高(OR=1.682,CI:1.032~4.205,P<0.05)为影响结核性脑膜炎早期诊断的独立因素。结论结核性脑膜炎早期诊断影响因素较多,医务人员应提高对结核性脑膜炎的认知、重视,把临床症状与各种辅助检查结合起来,综合判断,以提高结核性脑膜炎早期的诊治率。
Objective To explore the influential factors of early diagnosis of tuberculous meningitis and to take appropriate countermeasures to improve the early diagnosis and treatment of tuberculous meningitis. Methods 82 patients with early stage of tuberculous meningitis were selected from February 2010 to February 2016. 321 patients with suspected tuberculous meningitis were enrolled in the same period. Clinical data of all patients were collected. Related factors of early diagnosis of meningitis. Results Univariate analysis showed that the clinical manifestations of early diagnosis of tuberculous meningitis were headache or neck pain, fever, mental abnormalities or hemiplegia and meningeal irritation (P <0.05, P <0.01). The imaging examination was intracerebral Cerebrospinal fluid pressure (CSF), lymphocyte ratio, chloride, sugar, protein, adenosine deaminase (ADA) (P <0.05, P <0.01) . Multivariate logistic analysis: Statistical analysis of univariate analysis of clinical manifestations or indicators included in the multivariate analysis, the results showed that headache or neck pain (OR = 1.840, CI: 1.031 ~ 4.659, P <0.05) (OR = 2.437, CI: 1.085-4.987, P <0.05), meningeal irritation (OR = 2.151, CI: 1.132-4.769, P < (OR = 2.293, CI: 1.182-4.868, P <0.05), protein≥500 mg / L (OR = 2.187, CI: 1.143-4.795, P <0.05) and the level of glucose≥2.5 (OR = 1.635, CI: 1.027 ~ 3.927, P <0.05), ADA level (OR = 2.835, CI: 1.313-5.879, 1.682, CI: 1.032-4.205, P <0.05) were independent factors affecting the early diagnosis of tuberculous meningitis. Conclusion There are many influencing factors in the early diagnosis of tuberculous meningitis. The medical staff should improve the cognition and attention to tuberculous meningitis. Combining the clinical symptoms with various auxiliary examinations and judging comprehensively to improve the early diagnosis and treatment of tuberculous meningitis rate.