本文選題：結(jié)核性腦膜炎 + 結(jié)腦評(píng)分標(biāo)準(zhǔn)��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1、了解結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn)診斷效能,評(píng)估該評(píng)分標(biāo)準(zhǔn)在臨床上的適用性;2、探討結(jié)核性腦膜炎患者預(yù)后不良的影響因素。方法:回顧性收集2012年1月至2016年12月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院且出院診斷為“結(jié)核性腦膜炎”或“結(jié)核性腦膜腦炎”或“結(jié)核性腦脊髓膜炎”病例的臨床資料,排除重復(fù)住院、病歷資料不完整、腦脊液病原學(xué)找到細(xì)菌或真菌證據(jù)、長(zhǎng)期用藥方案包含抗真菌藥物以及失訪的病例。采用結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn)對(duì)每例患者進(jìn)行評(píng)分并根據(jù)評(píng)分總分依次分為確診組、很可能組、可能組及不可能組。通過電話隨訪患者或熟知患者病情及現(xiàn)狀的家屬,一方面了解有無誤診病例,以隨訪確診方法作為參照,計(jì)算結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn)的診斷靈敏度;另一方面對(duì)患者使用改良Rankin量表評(píng)分(modified Rankin Scale,mRS)并根據(jù)mRS評(píng)分情況對(duì)患者預(yù)后進(jìn)行分組(mRS3分為預(yù)后良好,mRS≥3分為預(yù)后不良),分析預(yù)后不同兩組病例的臨床資料,進(jìn)一步探討結(jié)核性腦膜炎患者預(yù)后不良的影響因素。結(jié)果:(1)結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn)的效能評(píng)價(jià):根據(jù)結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn),納入確診組0例,很可能組56例(32.75%),可能組109例(63.74%),不可能組6例(3.51%);根據(jù)隨訪結(jié)果,確診為結(jié)核性腦膜炎為157例(91.81%),確診為非結(jié)核性腦膜炎為14例(8.19%)。以隨訪結(jié)果分組方法作參照,計(jì)算出結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn)診斷的靈敏度為96.18%;(2)影響預(yù)后的危險(xiǎn)因素:對(duì)隨訪確診為結(jié)核性腦膜炎的157例患者根據(jù)mRS評(píng)分再次分組,其中預(yù)后良好組129例(82.17%),預(yù)后不良組28例(17.83%)。對(duì)2組患者的病例資料中可能與預(yù)后相關(guān)的各項(xiàng)因素進(jìn)行單因素統(tǒng)計(jì)學(xué)分析,結(jié)果顯示性別、病理征陽(yáng)性、意識(shí)障礙、腦積水、腦梗死、結(jié)核瘤、是否鞘注、是否早期應(yīng)用糖皮質(zhì)激素、糖皮質(zhì)激素使用方式、開始抗結(jié)核距離發(fā)病的時(shí)長(zhǎng)、腦脊液蛋白、腦脊液氯化物共12個(gè)單因素在2組之間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)以上有統(tǒng)計(jì)學(xué)意義的變量進(jìn)行二元logistic逐步回歸分析,開始抗結(jié)核距離發(fā)病的時(shí)長(zhǎng)(P=0.001,OR=1.017,95%CI:1.007~1.028)、意識(shí)障礙(P=0.004,OR=4.324,95%CI:1.578~11.851)、病理征陽(yáng)性(P=0.011,OR=3.968,95%CI:1.368~11.505)為預(yù)后不良的獨(dú)立危險(xiǎn)因素。結(jié)論:(1)結(jié)核性腦膜炎評(píng)分標(biāo)準(zhǔn)在早期診斷結(jié)核性腦膜炎中具有良好的預(yù)測(cè)價(jià)值,可以在臨床上積極推廣使用;(2)開始抗結(jié)核距離發(fā)病的時(shí)長(zhǎng)、意識(shí)障礙、病理征陽(yáng)性是結(jié)核性腦膜炎預(yù)后不良的獨(dú)立危險(xiǎn)因素;(3)早期診斷和治療對(duì)于改善結(jié)核性腦膜炎預(yù)后有關(guān)鍵作用。
[Abstract]:Objective to investigate the diagnostic efficacy of tuberculous meningitis scoring criteria and evaluate the clinical applicability of the criteria to explore the factors affecting the poor prognosis of patients with tuberculous meningitis. Methods: the clinical data of patients with tuberculous meningitis or tuberculous meningitis were collected retrospectively from January 2012 to December 2016 in the first affiliated Hospital of Guangxi Medical University. Exclusion of repeated hospitalization incomplete medical records cerebrospinal fluid etiology found evidence of bacteria or fungi long-term regimen including antifungal drugs and missing cases. According to the total score of tuberculous meningitis, the patients were divided into the definite group, the probable group, the possible group and the impossible group. The diagnostic sensitivity of tuberculous meningitis score was calculated by telephone follow-up or family members who were familiar with the condition and current situation of the patients, on the one hand, to find out whether there were misdiagnosis cases, and to calculate the diagnostic sensitivity of tuberculous meningitis score standard with the method of follow-up. On the other hand, the patients were evaluated with modified Rankin scale (modified Rankin scale / mRSs) and according to the mRS score, the patients were divided into two groups: good prognosis and poor prognosis. The clinical data of the two groups with different prognosis were analyzed. To further explore the prognostic factors of tuberculous meningitis. Results the effectiveness evaluation of tuberculous meningitis score: according to the tuberculous meningitis score standard, there were 0 cases in the diagnosed group, 56 cases in the most likely group, 63.74% in 109 cases, 6 cases in the impossible group, according to the results of follow-up. 157 cases were diagnosed as tuberculous meningitis and 14 cases as non-tuberculous meningitis. The sensitivity of diagnostic criteria for tuberculous meningitis was 96.18 / 2) and the prognostic risk factors were calculated. According to the mRS score, 157 patients with tuberculous meningitis were subdivided into two groups. There were 129 cases with good prognosis (82.17 cases) and 28 cases with poor prognosis (17.83%). Univariate statistical analysis was carried out on the factors related to prognosis in the case data of the two groups. The results showed that sex, positive pathological sign, disturbance of consciousness, hydrocephalus, cerebral infarction, tuberculoma, sheath injection or not. Whether the early use of glucocorticoid, glucocorticoid use mode, the onset of anti-tuberculosis time, cerebrospinal fluid protein, cerebrospinal fluid chloride a total of 12 single factors between the two groups had statistical significance (P 0.05). The binary logistic stepwise regression analysis of the above statistically significant variables showed that the time between the onset of anti-tuberculosis and the onset of tuberculosis was 1.01795 CI: 1.007 / 1.007 / 1.028, P0.004: 4.3245CIW 1.57811.851. the positive pathological sign P0.011ORT 3.969595 CIW 1.368Cw 11.505) were independent risk factors for poor prognosis. Conclusion the score standard of tuberculous meningitis has good predictive value in early diagnosis of tuberculous meningitis, and can be popularized in clinical practice. Positive pathological sign is an independent risk factor for poor prognosis of tuberculous meningitis. Early diagnosis and treatment play a key role in improving prognosis of tuberculous meningitis.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R529.3

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