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目的探讨结核性脑膜炎(tuberculous meningitis,TBM)的临床特点及治疗。方法回顾性分析30例结核性脑膜炎在抗结核化疗和鞘内注射前后的临床表现及脑脊液(CSF)检查(常规、生化、乳酸LA、腺苷脱氨酶ADA)的变化,评价其治疗效果。结果临床治愈23例,3例遗留肢体瘫痪,2例植物生存状态,2例动眼神经损伤;治疗前CSF细胞数、蛋白质、LA、ADA均明显升高,氯化物明显下降;治疗第4周CSF细胞数、蛋白质、LA、ADA均明显下降,氯化物上升;恢复期CSF细胞数和蛋白质、LA、ADA下降更明显,氯化物升高更明显。结论结核性脑膜炎治疗的关键在于早发现、早治疗,抗结核化疗、全身激素治疗及鞘内注射,脑脊液LA、ADA及氯化物可作为判断早期治疗效果及预后的指标。
Objective To investigate the clinical features and treatment of tuberculous meningitis (TBM). Methods The clinical manifestations of 30 patients with tuberculous meningitis before and after antituberculous chemotherapy and intrathecal injection were retrospectively analyzed, and the changes of cerebrospinal fluid (routine, biochemical, lactate LA and adenosine deaminase ADA) were analyzed to evaluate the therapeutic effect . Results The results of clinical cure in 23 cases, 3 cases of left limb paralysis, 2 cases of plant survival, 2 cases of oculomotor nerve injury; before treatment, the number of CSF cells, LA, ADA were significantly increased, chloride decreased significantly; CSF cell number, protein, LA, ADA were significantly decreased, chloride increased; recovery of CSF cell number and protein, LA, ADA decreased more significantly, more significantly elevated chloride. Conclusions The key to the treatment of tuberculous meningitis is early detection, early treatment, anti-tuberculosis chemotherapy, systemic hormone therapy and intrathecal injection. Cerebrospinal fluid LA, ADA and chloride can be used as indicators to judge early treatment and prognosis.