| Objective:Tuberculous meningitis?TBM?is the non-purulent inflammation of the central nervous system caused by mycobacterium tuberculosis?MTB?.Arachnoid,leptomeningeal,cerebrovascular and brain parenchyma are mainly invaded in pathology.Central nervous system tuberculosis is the most severe tuberculosis?TB?,accounts for 1%of all active TB.Early diagnosis and treatment is the key to improve the prognosis of patients with TBM.Early,appropriate,reasonable and effective treatment can quickly relieve symptoms and improve patients' prognosis,and reduce complications.Epidemiological characteristics and clinical manifestations of TBM have changed in recent years.To analyze and study the epidemiological and clinical characteristics of patients with TBM,so as to provide a basis for Early diagnosis and reasonable treatment.The epidemiological and clinical manifestations of 1873 TBM patients,who were treated in Shandong province in 2007-2016,were collected.The TBM patient's sex,age,region,occupation and time of onset distributions,summary onset epidemiological characteristics,clinical manifestations,Auxiliary examination,treatment and outcome were analyzed retrospectively.Methods:1.Data collection All patients of tuberculosis meningitis,who were registered in Shandong province in 2007-2016,come from" network direct report system of national infectious disease ".Population data of Shandong province in 2007-2016 data come from the national information system for disease surveillance and basic information system of population.2.Method To collect epidemic monitoring data of tuberculous meningitis of 17 cities in Shandong province from 2007 to 2016,through network direct report system of national infectious disease.TBM patient's incidence,"three" distribution of the population,summary onset epidemiological characteristics,clinical manifestations,Auxiliary examination,treatment and outcome were analyzed retrospectively.3.Clinical diagnostic criteria?1?.the following one or more of the signs and symptoms of meningitis:Headache,irritability,vomiting,fever,neck stiffness,seizures and focal neurologic deficits,disturbance of consciousness or bumout.?2?.the patient shall comply with the standards of A or B:A.clinical standard,with one or more of the following at the same time,Found acid-fast bacilli in CSF,TB culture positive in CSF,tuberculosis bacterium nucleic acid testing positive in CSF.B.found acid bacteria in the brain or spinal cord or tuberculosis venereal change,also have some clinical signs and the corresponding changes of CSF or autopsy meningeal.4.Examination methods Lumbar puncture were performed after patients were hospitalized,the part of the CSF was tested,to detect Adenosine deaminase?ADA?,interleukin-23?IL-23?,lactic acid,protein,sugar and chloride.The CSF of patients were tested again After a year of treatment.ADA and lactic acid using enzymatic,instrument for Hitachi biochemical analyzer and reagent provided by desai diagnosis system?Shanghai?co.LTD.;IL-23 experiment using ELISA method,kit purchased from Shanghai's male science and technology industrial co.LTD.5.laboratory index normal range lactic acid 1.0-2.8mmol/L,sugar 2.5-4.4mmol/L,ADA3.5-5.5U/L,IL-23 9.4-11.2pg/ml,Protein0.20-0.45g/l,Chloride120-130 mmol/L.6.Treatment Quadri-combination therapy?Isoniazide,rifampicin,pyrazinamide and streptomycin?of anti-TB drugs was used for all patients:Period of treatment is 1-1.5 years.Isoniazide?INH?:10-20 mg/?kg · d?,the most a large number of not more than 400 mg/d,the period of treatment is 1-1.5 years.Patients was given vitamin B6 to prevent multiple peripheral neuropathy and other side effects at the same time.Rifampicin:10-15 mg/?kg · d?,the largest amount of not more than 450 mg/d,the period of treatment is 6-9 months,1 year if necessary.Streptomycin?SM?:20-30 mg/?kg · d?,the largest amount of not more than 750 mg/d,the period of treatment is 1 years.muscle note 1 times a day or Every other day at a time after 1-2 months,because it can cause hearing and vestibular function damage.Pyrazinamide:20-30 mg/?kg · d?,the most a large number of not more than 1.5 g/d,the period of treatment is 3-6 months.442 hydrocephalus patients with tuberculous meningitis were injected anti-tuberculosis drugs in intrathecal:INH 20-50 mg/times,2-4 weeks for a course,the total of 1-3 period of treatment.Among them,33 patients with severe obstructive hydrocephalus eminence intraventricular external drainage,12 patients with severe traffic sex hydrocephalus in TB control symptoms after ventricle peritoneal shunt.7.Evaluation of treatment effect follow-up after treatment,record the clinical symptoms reduce time of the patient,application of PCR technique to test ADA,IL-23 and TB-DNA in CSF,application of acid dyeing technique to measure acid bacillus,protein,sugar,and chloride content in CSF.Detection the pressure of CSF,to evaluate the efficacy of treatment.Clinical curative effect evaluation standard:excellent,Clinical symptoms disappear,the result of ADA,IL-23,sugar,protein,chlorine,TB-DNA and acid bacillus is normal,effective,clinical symptoms relieve,the result of ADA,IL-23,sugar,protein,chlorine,TB-DNA and acid bacillus better than before.Invalid:clinical symptom have no obvious better or worse,the result of ADA,IL-23,sugar,protein,chlorine,TB-DNA and acid bacillus has no obvious change.8.Statistical analysis The data is input Excel2003 statistical software for statistical analysis,using SPSS 17.0 statistical software for statistical analysis of bilateral inspection,the comparison of measured value variance analysis between the three group,compare the difference between the two groups using t test,with P<0.05 for the difference was statistically significant.Results:1.Annual incidence A total of 1873 patients with tuberculous meningitis in Shandong province from 2007 to 2016 in each of the years,were reported.The average annual incidence is 0.23/10thousand,incidence range of 0.06-0.41/1 0thousand.The highest incidence of tuberculous meningitis is 2007 per 0.41/10thousand?306 cases?and the lowest is 2016 per 0.06/10thousand?58 cases?,the report showed a trend of decline the incidence.2.Regional distribution From 2007 to 2016,tuberculous meningitis disease occured in 17 cities of Shandong province.Heze,the maximum number of reported cases in 232 cases,accounting for 12.39%of the total number of cases?232/1873?;Followed by Linyi,Jining and Liaocheng,were 11.16%?209/1873?,11.16%?174/1873?and 8.65%?162/1873?retrospectively.From the incidence of the disease,heze incidence thousands of 0.97/10thousand is the highest,the second is the Liaocheng,Linyi and Jining,thousands of 0.86/10thousand,0.71/10thousand and 0.49/10thousand respectively.Outbreak of 2007-2016,incidence of Yantai,Weihai and Rizhao was significantly lower,by 2007 thousands of 0.21/10thousand,0.21/10thousand,0.20/10thousand fell to thousands of 2016,0.10/10thousand,0.09/10thousand,0.09/10thousand.3.Age distribution 1873 cases of tuberculous meningitis occurred on every age group,the onset age concentrated in 30 to 60 years old,which was accounted for 73.41%?1375/1873?.4.Gender distribution Most of the patients of 1873 cases of tuberculous meningitis were male,1569 cases,accounting for 83.77%,while female 304 cases,accounting for 16.23%.The sex ratio is 5.16:1.00.5.Professional distribution Most of the patients lived in rural areas,which was accounted for 79.07%?1481/1873?.The rest was the housework unemployment,student,catering services,former researchers,scattered children,workers and medical personnel.6.Time and seasonal distribution 1873 cases of tuberculous meningitis occurred throughout the year,the onset time concentrated on November to April,which was accounted for 66.04%?1237/1873?.The onset Show obvious seasonal cycle,the peak of the incidence in Autumn and winter.7.Clinical manifestations 1431 cases were tuberculous meningitis,which was accounted for 76.40%?1431/1873?.442 hydrocephalus patients with tuberculous meningitis,which was accounted for 23.60%?442/1873?.The majority of clinical manifestations were headache,low thermal,1809 cases and 1799 cases,which were accounted for 96.58%and 96.05%respectively.The rest was weakness and neck stiffness,1303 cases and 1211 cases,which were accounted for 69.57%and 69.57%respectively.8.Auxiliary examination The results were as following:1764 cases of cerebrospinal fluid pressure rose?94.18%?,1428 cases of CSF white blood cell count increased?76.24%?,937 cases of CSF protein rose?50.03%?,1252 cases of CSF chloride reduced?66.84%?.1368 cases of CSF glucose lowered?73.04%?,1328 cases of ADA rose?70.90%?,1402 cases of IL-23 rose?74.85%?,1185 cases of X-ray sternum examination revealed tuberculosis lesions?63.27%?,793 cases of Brain CT and MR found brain abnormalities?42.34%?.The detection rate of CSF bacterial smear and bacteria culture and tuberculin skin test positive rate were low.9.0utcome The results were as following:1445 cases recovered well?77.15%?,428 cases restored bad?22.85%?,and 47 cases of death?2.51%?.The patients of hydrocephalus group,the tuberculous Meningitis group and the control group of excellent,effective and ineffective were 36.13%,51.43%and 12.44;13.35%,30.09%and 56.56%;23.80%,62.20%and 14.00%respectively.Three groups was statistically significant difference?Kruskal Wallis x2=11.541,p<0.001?.The results difference of ADA,IL-23,lactic acid,glucose,protein,sugar and chloride laboratory index in the three groups was statistically significant?F=27.98,53.46,27.98,18.47,11.74 and 26.09,p<0.001 or 0.001?.Meningitis group and hydrocephalus group after treatment in patients with cerebrospinal fluid ADA,IL-23,lactic acid,protein,sugar and chloride laboratory index difference had statistical significance?t=32.04,64.45,78.75,32.91,42.73,52.64 and 26.93,76.94,38.87,21.95,27.65,46.03,p<0.001?.Meningitis group with hydrocephalus patients before and after the treatment of cerebrospinal fluid ADA,IL-23,lactic acid,protein,sugar and chloride laboratory index comparison,differences were statistically significant?t=8.80,41.24,11.26,22.58,11.20,20.38 and 11.80,27.04,11.92,8.98,11.92,8.55,p<0001?.Conclusions:1.In recent years,the incidence of TBM in Shandong province is on the decline,the annual incidence reduced year by year,the coastal economic underdeveloped regions in men,mature,the farmers are the main TBM onset patients,Autumn and Winter of TBM is high.2.In recent years,the clinical manifestations of patients with TBM in Shandong province in the majority with light duty patients,curative effect is better;Heavy duty mainly patients with tuberculosis meningitis and hydrocephalus,curative effect is poorer..Early diagnosis and treatment is the key to improving the prognosis of patients.3.TBM in cerebrospinal fluid in the patients with ADA,IL-23,lactic acid,protein,sugar and chloride and other indicators are abnormal change,and after regular anti-TB treatment can significantly improve. |
PDF Full Text Request