Analysis Of Clinical Features And Prognostic Factors Of42 Tuberculous Meningitis Patients

ObjectivesBy analyzing the clinical symptoms and signs,laboratory examination and imaging examination of patients with tuberculous meningitis,the clinical characteristics and prognostic factors of tuberculous meningitis were discussed to guide their clinical diagnosis and treatment.MethodsClinical data of 42 patients newly diagnosed with tuberculous meningitis were collected(including basic information,clinical symptoms and signs,laboratory examination results,imaging examination results,prognosis on discharge)in the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2018.According to the assessment of Modified Rankin Score(m RS),the prognosis at discharge was divided into two groups.A m RS score of 0-2 points was considered to have a good prognosis,while a m RS score of 3 to 6 points was considered to have a poor prognosis.The above clinical data were analyzed retrospectively.T test was used for comparison between measurement data groups,chi-square test was used for comparison between counting data groups,and Logistic regression analysis was used for multivariate analysis.(P<0.05 was considered statistically significant).Results1. A total of 42 patients were included in this study,including 25 males and 17 females,with an average age of 45.93±19.58 years.Among them,13 patients had poor prognosis and 29 patients had good prognosis.Three cases were fatal,with a case fatality rate of7.14%.2. Common clinical symptoms of tuberculous meningitis are fever(95.24%),headache(78.57%),nausea and vomiting(54.76%);clinical signs are meningeal irritation(71.43%),disturbance of consciousness(61.90%),peripheral neurological dysfunction(54.76%).3. Cerebrospinal fluid examination of white blood cell count,protein,glucose,chloride content abnormal accounted for 100%,95.24%,78.57%,90.48%.There were 39 cases examined by cranial imaging,the most common findings were meningitis(46.15%),acute cerebral infarction(10.26%),and intracranial hemorrhage(7.69%).4. After univariate analysis,Medical Research Council(MRC)staging system(?~2=25.537,P=0.000),disturbance of consciousness(?~2=4.118,P=0.042),cranial nerve palsy(?~2=6.740,P=0.009),peripheral nerve dysfunction(?~2=10.714,P=0.001),seizure(?~2=6.389,P=0.011),peripheral blood white blood cell count,neutrophils ratio(t=2.286,P=0.028),C-reactive protein(t=2.846,P=0.007),cerebrospinal fluid protein content(t=3.846,P=0.000),hydrocephalus(?~2=4.685,P=0.030)and tuberculous tumor formation(?~2=4.685,P=0.030)had statistically significant differences among different prognostic groups.5. Multivariate analysis showed that peripheral nerve dysfunction[OR=12.969,95%CI(1.080,155.678),P=0.043],cranial nerve palsy[OR=13.339,95%CI(1.238,143.663),P=0.033]and increased cerebrospinal fluid protein content[OR=6.006,95%CI(1.131,31.894),P=0.035]were independent risk factors for poor prognosis of tuberculous meningitis.ConclusionsClinical symptoms and signs of tuberculous meningitis are diverse,and some patients lack typical clinical manifestations.Cerebrospinal fluid examination and cranial imaging are important means of diagnosis.Factors influencing the prognosis of tuberculous meningitis are complex.Peripheral nerve dysfunction,cranial nerve palsy and increased cerebrospinal fluid protein content are independent risk factors for poor prognosis of tuberculous meningitis,which should be observed in clinical diagnosis and treatment.