摘要
目的分析无神经系统症状/体征的肺结核(PTB)合并结核性脑膜炎(TBM)患儿的早期临床特征,为临床诊疗提供参考。方法回顾性收集初诊初治PTB合并TBM患儿84例,其中无神经系统症状/体征的PTB合并TBM(NS-PTB-TBM)患儿46例(NS-PTB-TBM组),有神经系统症状/体征的PTB合并TBM(S-PTB-TBM)患儿38例(S-PTB-TBM组)。比较两组一般资料、实验室及影像学检查等相关临床指标,采用多因素Logistic回归分析PTB合并TBM患儿不表现出神经系统症状/体征的影响因素。结果NS-PTB-TBM组年龄≥10岁比例、咳嗽比例、营养不良比例、白细胞计数≥12×109/L比例及外周血C反应蛋白(CRP)、乳酸脱氢酶、球蛋白、腺苷脱氨酶(ADA)水平均高于S-PTB-TBM组,外周血白蛋白、高密度脂蛋白水平均低于S-PTB-TBM组(P均<0.05)。NS-PTB-TBM组痰/胃液MTB涂片、核酸阳性率及小叶中心结节、树芽征、肺门/纵隔淋巴结肿大、弥漫粟粒改变比例均高于S-PTB-TBM组,钙化比例低于S-PTB-TBM组(P均<0.05)。多因素Logistic分析结果显示,咳嗽、CRP升高、ADA升高是促进初诊初治时PTB合并TBM患儿不表现出神经系统症状/体征的独立危险因素。结论NS-PTB-TBM患儿在初诊初治时表现出更活跃的炎症反应和特定的影像学特征,外周血CRP和ADA水平升高可能是患儿不表现出神经系统症状/体征的独立危险因素。
Objective To investigate the early clinical characteristics of pediatric patients with pulmonary tuberculo-sis(PTB)complicated with tuberculous meningitis(TBM)who exhibit no neurological symptoms or signs,in order to pro-vide a reference for clinical diagnosis and treatment.Methods A retrospective study was conducted on 84 pediatric pa-tients newly diagnosed and initially treated for PTB complicated with TBM.Patients were classified into two groups:those without neurological symptoms/signs(NS-PTB-TBM group,n=46)and those with neurological symptoms/signs(S-PTB-TBM group,n=38).Demographic characteristics,laboratory test results,and radiological findings were compared be-tween the groups.Multivariate Logistic regression analysis was used to identify the factors associated with the absence of neurological symptoms/signs in pediatric patients with PTB complicated with TBM.Results Compared with the S-PTB-TBM group,the NS-PTB-TBM group exhibited significantly higher proportions of patients aged≥10 years,cough,malnu-trition,white blood cell counts≥12×109/L,and elevated peripheral blood levels of C-reactive protein(CRP),lactic de-hydrogenase,globulin,and adenosine deaminase(ADA);conversely,albumin and high-density lipoprotein(HDL)lev-els were significantly lower in the NS-PTB-TBM group(all P<0.05).Radiological evaluations demonstrated higher positiv-ity rates for sputum/gastric aspirate Mycobacterium tuberculosis(MTB)smear and nucleic acid amplification tests in the NS-PTB-TBM group,alongside increased frequencies of centrilobular nodules,tree-in-bud signs,hilar/mediastinal lymph-adenopathy,and diffuse miliary changes,and with a lower incidence of calcification(all P<0.05).Multivariate Logistic regression analysis revealed cough,elevated CRP,and elevated ADA were independent factors for the absence of neurolog-ical symptoms/signs at initial diagnosis.Conclusions Pediatric patients with NS-PTB-TBM exhibit more active inflam-matory responses and distinct radiological features at initial diagnosis and treatment.Elevated peripheral blood CRP and ADA levels are independent risk factors for the absence of neurological symptoms or signs in these patients.
作者
郑圣坤
黄绍梅
马尚明
郭慧莲
ZHENG Shengkun;HUANG Shaomei;MA Shangming;GUO Huilian(Pediatric Department,Guangzhou Chest Hospital,Guangzhou 510095,China)
出处
《山东医药》
2025年第4期16-20,共5页
Shandong Medical Journal
基金
广东省广州市卫生健康科技一般引导项目(20251A010030)。
关键词
肺结核
结核性脑膜炎
神经系统症状
早期诊断
儿童疾病
pulmonary tuberculosis
tuberculous meningitis
neurological symptoms
early diagnosis
pediatric diseases
