| Objective: In order to guide clinical practice,the clinical characteristics of tuberculous meningitis in children and the influencing factors of curative effect were analyzed.Methods: The data of 92 cases of children with tuberculous meningitis diagnosed at the hospital of children affiliated to Chongqing Medical University from Januray 2015 to December 2016 were collected,including the basic clinical data of hospitalized children(sex,age,urban and rural distribution,pathogenic seasons,BCG vaccination history,tuberculosis contact history,visit time course),clinical manifestation,complications,cerebrospinal fluid examination and treatment were analyzed retrospectively.At the same time,logistic regression analysis was used to further explore the related factors affecting the curative effect of tuberculous meningitis in children.Results:(1)There were 42 cases of male children and 50 cases of female children,the ratio of male to female was 1: 1.19;(2)There were 27 cases(29.35%)in 0 to 3 years old,17 cases(18.48%)in 4 to 7 years old,26 cases(28.26%)in 8 to 12 years old,22 cases(23.91%)over 12 years old,the average age of onset was 7.76 ±5.14 years old;(3)60 cases(65.22%)from rural areas,32 cases(34.78%)from cities;(4)The number of cases occurring in spring,summer,autumn and winter in turn was 22?26?25?19,Showing a trend of distribution throughout the year;(5)59 cases(64.13%)were vaccinated with BCG,14 cases(15.22%)were not vaccinated with BCG(15.22%),and the other 19 cases(20.65%)were unknown;(6)There were 27 cases(29.35 %)with clear tuberculosis contact history,24 cases were close contact family members,accounting for 88.89 %,and 10 cases were infants,accounting for 37.04%;(7)The visit time course of the disease ranged from 3 to 40 days,with an average duration of approximately 17.08 ± 9.08 days;(8)The main clinical manifestations were fever(88.04)%,headache(50.05%),vomiting(29.35%),meningeal stimulation(33.92%),the Infants and young children may have non-specific manifestations such as personality change(2.17%),anterior fontanelle protuberance(1.09%),etc,severe cases with convulsion(19.57%),disturbance of consciousness(16.30%),and even coma(1.09%);(9)There were 10 cases without extracranial tuberculosis(ECTB)and 82 cases with extracranial tuberculosis;Among extracranial tuberculosis,80 cases(97.56%)had pulmonary tuberculosis,14 cases(17.07%)had abdominal tuberculosis,6 cases(7.32%)had tuberculous pleurisy,2 cases(2.44%)had urinary tuberculosis and endobronchial tuberculosis(EBTB),and there were 1 cases(1.22%)of thoracic tuberculosis,tuberculosis of spleen and renal tuberculosis;(10)Cerebrospinal fluid(CSF)examination was performed in 85 cases,62 cases(72.94%)the number of cells was increased,55 cases(64.70%)the protein content was increased,39 cases(45.88%)the glucose content was decreased,and the content of chloride was decreased in 45 cases(52.94%);(11)Univariate analysis showed that age,clinical stage,convulsion and glucocorticoid were significantly different from the curative effect(P < 0.05).Logistic regression analysis showed that smaller the age and the later clinical stage are independent risk factors for the curative effect of tuberculous meningitis.Conclusion:(1)Tuberculous meningitis in children was more common in infants,followed by school-age children,mostly in rural areas;(2)Children with fever,headache,vomiting and meningeal irritation sign should inquire about the history of tuberculosis contact to prevent missed diagnosis of tuberculous meningitis;(3)Small age,late clinical stage,convulsion and no glucocorticoid therapy were the risk factors affecting the curative effect of tuberculous meningitis;(4)Young age and late clinical staging are independent risk factors for the curative effect of tuberculous meningitis. |
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