目的:通过分析儿童结核性脑膜炎(tuberculous meningitis,TBM)患者的临床特征和预后相关的危险因素,为儿童TBM高危患者的早期识别和干预提供有效依据。方法:回顾性收集2013年1月1日至2023年12月31日上海市(复旦大学附属)公共卫生临床中...目的:通过分析儿童结核性脑膜炎(tuberculous meningitis,TBM)患者的临床特征和预后相关的危险因素,为儿童TBM高危患者的早期识别和干预提供有效依据。方法:回顾性收集2013年1月1日至2023年12月31日上海市(复旦大学附属)公共卫生临床中心首次诊断为TBM儿童患者的资料。根据门诊和电话相结合的方式,采用改良兰金量表(modified Rankin scale,mRS)评估儿童TBM抗结核治疗12个月后的神经系统结局,比较预后良好和预后不良两组患儿的临床特征,采用单因素和多因素分析识别和预后不良相关的因素。结果:研究共纳入TBM儿童患者91例,其中,62例预后良好,29例预后不良。患儿年龄的中位数(四分位数)为3.00(1.00,8.00)岁,51例为男性患儿。入院时预后不良组发生肌力异常(12/29,41.38%)、神志不清(16/29,55.17%)、脑积水(17/29,58.62%)的比例均高于预后良好组[分别为(9/62,14.52%)、(13/62,20.97%)和(22/62,35.48%)](χ^(2)=8.032,P=0.005;χ^(2)=10.647,P<0.001;χ^(2)=4.319,P=0.038);发生咳嗽≥2周(4/29,13.79%)和咳痰(1/29,3.45%)的比例则低于预后良好组[分别为(21/62,33.87%)、(13/62,20.97%)](χ^(2)=3.997,P=0.046;χ^(2)=4.659,P=0.031);预后不良组的格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分比预后良好组更低(13和15;Z=-4.190,P<0.001),英国医学研究委员会(Medical Research Council,MRC)疾病分期差异具有统计学意义(χ^(2)=22.327,P<0.001)。此外,预后不良组的脑脊液(cerebrospinal fluid,CSF)乳酸脱氢酶含量[中位数(四分位数):60.00(29.50,128.00)IU/L]、使用外脑室引流术(7/29,24.14%)以及机械通气(19/29,65.52%)的比例均高于预后良好组[分别为39.50(20.75,64.00)IU/L、(2/62,3.23%)、(25/62,40.32%)](Z=-2.100,P=0.036;χ^(2)=9.696,P=0.002;χ^(2)=5.022,P=0.025)。多因素logistic分析结果显示入院神志不清(OR=3.690;95%CI:1.045~13.034;P=0.043)和使用外脑室引流(OR=8.041;95%CI:1.064~60.760;P=0.043)是儿童TBM患者预后不良的独立危险因素。结论:预后不良儿童TBM患者更多表现为严重神经系统症状(如肌力异常、低GCS评分)、脑积水及CSF乳酸脱氢酶升高,且机械通气需求更高。而预后良好组呼吸道症状(如咳嗽、咳痰)更突出,可能提示早期就诊或疾病较轻。入院神志不清、外脑室引流是提示预后不良的独立危险因素。展开更多
Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low...Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low-and middle-income regions(e.g.,sub-Saharan Africa and Southeast Asia),threatening the lives of patients and imposing significant psychosocial burdens.Recent studies have highlighted the crucial role of psychosocial factors,including socioeconomic status,disease severity,and social support systems in recovery.However,research gaps persist in developing TBM-specific psychosocial interventions.This narrative review summarizes and organizes the key findings of observational studies,cohort studies,and intervention trials published between 2015 and 2024.Databases including PubMed,Scopus,and Web of Science were searched for terms related to TBM,psychosocial risk factors and mental health interventions.Studies were screened for relevance and quality,focusing on those that examined the psychological and social determinants of mental health outcomes in patients with TBM.展开更多
文摘目的:通过分析儿童结核性脑膜炎(tuberculous meningitis,TBM)患者的临床特征和预后相关的危险因素,为儿童TBM高危患者的早期识别和干预提供有效依据。方法:回顾性收集2013年1月1日至2023年12月31日上海市(复旦大学附属)公共卫生临床中心首次诊断为TBM儿童患者的资料。根据门诊和电话相结合的方式,采用改良兰金量表(modified Rankin scale,mRS)评估儿童TBM抗结核治疗12个月后的神经系统结局,比较预后良好和预后不良两组患儿的临床特征,采用单因素和多因素分析识别和预后不良相关的因素。结果:研究共纳入TBM儿童患者91例,其中,62例预后良好,29例预后不良。患儿年龄的中位数(四分位数)为3.00(1.00,8.00)岁,51例为男性患儿。入院时预后不良组发生肌力异常(12/29,41.38%)、神志不清(16/29,55.17%)、脑积水(17/29,58.62%)的比例均高于预后良好组[分别为(9/62,14.52%)、(13/62,20.97%)和(22/62,35.48%)](χ^(2)=8.032,P=0.005;χ^(2)=10.647,P<0.001;χ^(2)=4.319,P=0.038);发生咳嗽≥2周(4/29,13.79%)和咳痰(1/29,3.45%)的比例则低于预后良好组[分别为(21/62,33.87%)、(13/62,20.97%)](χ^(2)=3.997,P=0.046;χ^(2)=4.659,P=0.031);预后不良组的格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分比预后良好组更低(13和15;Z=-4.190,P<0.001),英国医学研究委员会(Medical Research Council,MRC)疾病分期差异具有统计学意义(χ^(2)=22.327,P<0.001)。此外,预后不良组的脑脊液(cerebrospinal fluid,CSF)乳酸脱氢酶含量[中位数(四分位数):60.00(29.50,128.00)IU/L]、使用外脑室引流术(7/29,24.14%)以及机械通气(19/29,65.52%)的比例均高于预后良好组[分别为39.50(20.75,64.00)IU/L、(2/62,3.23%)、(25/62,40.32%)](Z=-2.100,P=0.036;χ^(2)=9.696,P=0.002;χ^(2)=5.022,P=0.025)。多因素logistic分析结果显示入院神志不清(OR=3.690;95%CI:1.045~13.034;P=0.043)和使用外脑室引流(OR=8.041;95%CI:1.064~60.760;P=0.043)是儿童TBM患者预后不良的独立危险因素。结论:预后不良儿童TBM患者更多表现为严重神经系统症状(如肌力异常、低GCS评分)、脑积水及CSF乳酸脱氢酶升高,且机械通气需求更高。而预后良好组呼吸道症状(如咳嗽、咳痰)更突出,可能提示早期就诊或疾病较轻。入院神志不清、外脑室引流是提示预后不良的独立危险因素。
文摘目的探讨脑脊液(cerebrospinal fluid,CSF)和血清中结核性脑膜炎(tuberculous meningitis,TBM)特异性生物标志物对儿童TBM的鉴别诊断价值。方法采用前瞻性研究方法,将2020年11月至2022年11月期间在西安交通大学附属儿童医院就诊的46例确诊/疑似TBM患儿和48例非TBM患儿纳入研究。采用多重细胞因子芯片平台检测血清和CSF中69种生物标志物的浓度,包括7种既往研究报道对成人肺结核诊断有价值的生物标志物。结果在7种成人结核病诊断标志物中,仅补体因子H在儿童TBM鉴别中具有一定的临床意义,受试者工作特征曲线下面积(area under curve,AUC)为0.805(95%CI:0.715~0.894;P<0.001)。此外,基于4种标志物(趋化因子C-C-基元配体1、补体C5、纤溶酶原激活物抑制剂1和基质金属蛋白酶9)构建的新联合模型对儿童TBM诊断潜力显著,留一交叉验证后AUC为0.954(95%CI:0.907~1.000),灵敏度和特异度分别为92.9%和88.9%。在血清中验证,该联合模型的AUC为0.824(95%CI:0.740~0.907),但诊断效能低于CSF蛋白模型(P<0.05)。结论成人结核病标志物可能不适用于儿童TBM诊断。本研究提出的趋化因子C-C-基元配体1、补体C5、纤溶酶原激活物抑制剂1及基质金属蛋白酶9联合模型有望成为儿童TBM的鉴别诊断工具,且CSF样本的诊断价值优于血清样本。
文摘Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low-and middle-income regions(e.g.,sub-Saharan Africa and Southeast Asia),threatening the lives of patients and imposing significant psychosocial burdens.Recent studies have highlighted the crucial role of psychosocial factors,including socioeconomic status,disease severity,and social support systems in recovery.However,research gaps persist in developing TBM-specific psychosocial interventions.This narrative review summarizes and organizes the key findings of observational studies,cohort studies,and intervention trials published between 2015 and 2024.Databases including PubMed,Scopus,and Web of Science were searched for terms related to TBM,psychosocial risk factors and mental health interventions.Studies were screened for relevance and quality,focusing on those that examined the psychological and social determinants of mental health outcomes in patients with TBM.
