摘要
目的了解HREZMfxLzd治疗方案(异烟肼、利福平、乙胺丁醇、吡嗪酰胺、莫西沙星、利奈唑胺)对效果不佳结核性脑膜炎(TBM)患者预后的影响因素。方法选择成都市公共卫生临床医疗中心2017年1月至2020年6月采用HREZMfxLzd方案治疗的TBM患者89例作为研究对象,采用改良Rankin量表(mRS评分)评价预后,并根据预后分组,42例mRS<3分的患者为预后良好组,47例mRS≥3分的患者为预后不良组,比较两组患者基本资料、治疗情况、合并症及相关指标,将有统计学意义的指标纳入二元Logistic多元逐步回归方程,分析预后的影响因素。结果预后良好组发病至抗结核治疗时间和发热天数分别为(8.55±1.83)d和(16.72±2.57)d,均短于预后不良组,入院时格拉斯哥昏迷评分(GCS)和脑脊液氯化物水平分别为(12.33±2.28)分和(117.28±12.85)mmol/L,高于预后不良组;脑脊液蛋白浓度为(1.40±0.21)g/L,低于预后不良组,差异均有统计学意义(t=17.290、19.826、4.793、6.972和7.781,P均<0.05)。预后良好组伴意识障碍、脑梗死、脑积水的构成比例为9.52%、7.14%和2.38%,并发低钠血症的构成比例为16.67%,均低于预后不良组,差异均有统计学意义(χ^(2)=27.921、20.570、20.983和32.762,P<0.05)。Logistic回归分析显示,伴意识障碍、发病至抗结核治疗时间长、并发低钠血症、伴脑积水、伴脑梗死是影响TBM患者预后的主要因素(OR=1.935、4.293、6.372、3.642和3.971,95%CI=1.381~3.661、2.081~7.936、3.570~9.275、1.962~7.158和2.259~5.173)。结论发病至抗结核治疗时间是影响TBM患者预后不良的重要因素。采用HREZMfxLzd方案治疗时,如患者伴有意识障碍、并发低钠血症,脑梗死、脑积水往往预示预后不良。
Objective To understand the factors affecting the prognosis of patients with tuberculous meningitis(TBM)whose efficacy is not good for the treatment of isoniazid(H),rifampicin(R),ethambutol(E),pyrazinamide(Z),moxifloxacin(Mfx)and linezolid(Lzd)(HREZMfxLzd).Methods A total of 89 TBM cases treated with the HREZMfxLzd regimen in Chengdu Public Health Clinical Medical Center from January 2017 to June 2020 were selected as the research objects.The prognosis was evaluated by the modified Rankin scale(mRS score).According to the mRS score,the patients were divided into good prognosis group with mRS<3 scores(42 cases)and poor prognosis group with mRS≥3 scores(47 cases).Basic data,treatment status,comorbidities and related indicators of patients were collected for group comparison,and statistically significant indicators were included in the binary Logistic multivariate Stepwise regression equation to analyze the factors affecting prognosis.Results The onset to anti-tuberculosis treatment time and fever days in the good prognosis group were(8.55±1.83)d and(16.72±2.57)d,which were shorter than those in the poor prognosis group.Glasgow Coma Score(GCS)and the level of cerebrospinal fluid chlorine on admission were(12.33±2.28)score and(117.28±12.85)mmol/L,which were higher than those in the poor prognosis group.The level of cerebrospinal fluid protein was(1.40±0.21)g/L,which was lower than that in the poor prognosis group.The differences were statistically significant(t=17.290,19.826,4.793,6.972 and 7.781,P all<0.05).The proportions of disturbance of consciousness,cerebral infarction,hydrocephalus and hyponatremia in the good prognosis group were 9.52%,7.14%,2.38%and 16.67%,which were all lower than those in the poor prognosis group.The differences were statistically significant(χ^(2)=27.921,20.570,20.983 and 32.762,P all<0.05).Logistic regression analysis showed that the main factors affecting the prognosis of patients with TBM were disturbance of consciousness,long time of onset to treatment,hyponatremia,hydrocephal
作者
袁平
王亚娟
邹丽萍
Yuan Ping;Wang Yajuan;Zou Liping(Department of Tuberculosis,Chengdu Public Health Clinical Medical Center,Chengdu 610066,China)
出处
《国际流行病学传染病学杂志》
CAS
2021年第6期441-445,共5页
International Journal of Epidemiology and Infectious Disease
