The Diagnostic Value Of Fever And Serum Sodium Combined With The Percentage Of Neutrophils In Tuberculous Meningitis Secondary To Pulmonary Tuberculosis

Objective: To study the diagnostic value of fever and serum sodium combined with the percentage of neutrophils in tuberculous meningitis(TBM)secondary to pulmonary tuberculosis.Methods: From October 2015 to October 2018,146 patients with TBM secondary to pulmonary tuberculosis were selected as experimental group,and 584 patients with pulmonary tuberculosis non-secondary TBM in the same period were selected as control group in Anhui Provincial Chest Hospital.The efficiency of fever,the sodium,the percentage of neutrophils,and the combination of the three indexes in the diagnosis of TBM secondary to pulmonary tuberculosis were compared,and the critical point of the best serum sodium and percentage of neutrophils in the diagnosis of TBM secondary to pulmonary tuberculosis were determined.Results: 1.A total of 730 patients were successfully enrolled in the study,which included 146 patients in the experimental group,including 104 males and 42 females with an average age of(41.51 +19.70)years,while 584 patients were included in the control group,including 416 males and 168 females,aged 14 to 90 years(44.98 +19.21).There were no significant differences in sex and age between the experimental group and the control group(P>0.05).2.The fever,serum sodium and percentage of neutrophils of the control group and the experimental group were analyzed,and there were significant differences among them(P<0.01).The proportion of TBM secondary to pulmonary tuberculosis patients with febrile symptoms was higher than that of pulmonary tuberculosis non-secondary TBM.The serum sodium of TBM secondary to pulmonary tuberculosis patients was generally lower than that of pulmonary tuberculosis non-secondary TBM,and the percentage of neutrophils was generally higher.3.The area under the curve was tested by Z test,and the P value of pairwise comparison was more than 0.05,so there was no significant difference in the area under the curve.4.The best critical points of serum sodium and percentage of neutrophils for diagnosing patients with TBM secondary to pulmonary tuberculosis were 135.3mmol/l and 73.4% respectively;the maximum Yoden index for fever,serum sodium,percentage of neutrophils and the combination diagnosis of TBM secondary to pulmonary tuberculosis were 0.464,0.444,0.385 and 0.531 respectively;the sensitivity were 80.82%,56.85%,65.07% and 63.70%respectively;the specificity were 65.58%,87.5%,73.46% and 89.38% respectively;and the AUC were 0.732,0.768,0.727 and 0.845 respectively.Conclusion: 1.Fever,serum sodium <135.3mmol/l or percentage of neutrophils >73.4% have diagnostic significance for TBM secondary to pulmonary tuberculosis.2.Fever,serum sodium <135.3mmol/l or percentage of neutrophils >73.4% have no obvious advantages and disadvantages in the diagnosis of TBM secondary to pulmonary tuberculosis.3.The combination of the three indexes has higher diagnostic value for TBM secondary to pulmonary tuberculosis compared with one index.