赵娟娟

【摘要】 结核性脑膜炎（TBM）是一种由结核分枝杆菌引起的脑膜非化脓性炎症，可继发于血行播散型肺结核及其他器官的结核。TBM在结核分枝杆菌感染性疾病中表现形式最为多样，具有较高的死亡率、致残率，TBM患者预后与诊断是否及时及治疗措施是否有效有着极为密切的联系。但由于TBM患者早期临床症状缺乏特异性，极易被患者忽视，误诊率和漏诊率较高，大部分患者在病情确诊时，基本错过了最佳治疗时间。因此及早寻求一种特异性高、敏感度高的实验室诊断方法，并实施有效的治疗，是改善TBM患者预后的关键。本文从TBM诊断展开综述，前者主要包括临床表现、脑脊液检查、微生物学诊断、分子检测诊断、免疫学诊断、影像学检查、脑脊液宏基因组测序技术，后者包括常用药物、抗结核化疗、CSF置换、小儿TBM治疗、手术治疗等多。

【关键词】 结核性脑膜炎 免疫学检查 生化检查 抗结核治疗 CSF置换

doi：10.14033/j.cnki.cfmr.2020.16.073 文献标识码 A 文章编号 1674-6805（2020）16-0-04

Progress in Diagnosis and Treatment of Tuberculous Meningitis/ZHAO Juanjuan. //Chinese and Foreign Medical Research， 2020， 18（16）： -183

[Abstract] Tuberculous meningitis （TBM） is a kind of non suppurative inflammation of meninges caused by Mycobacterium tuberculosis， which can be secondary to hematogenous pulmonary tuberculosis and tuberculosis of other organs. TBM has the most diverse forms in the infectious diseases of Mycobacterium tuberculosis， with high mortality and disability rate. The prognosis of patients with TBM is closely related to whether the diagnosis is timely and whether the treatment measures are effective. However， due to the lack of specificity in the early clinical symptoms of TBM patients， it is easy to be ignored by patients， and the misdiagnosis rate and missed diagnosis rate are high. Most patients basically miss the best treatment time when they are diagnosed. Therefore， the key to improve the prognosis of TBM patients is to find a specific and sensitive laboratory diagnosis method as early as possible and to implement effective treatment. This article reviews the diagnosis and treatment of TBM. The former includes clinical manifestations， CSF examination， microbiological diagnosis， molecular detection diagnosis， immunological diagnosis， imaging examination， CSF macrogenomic sequencing technology， and the latter includes commonly used drugs， antituberculous chemotherapy， CSF replacement， TBM treatment for children， surgical treatment and so on.

[Key words] Tuberculous meningitis Immunological examination Biochemical examination Antituberculous treatment CSF replacement

First-authors address： Nanning Fourth Peoples Hospital， Nanning 530023， China

結核分枝杆菌可通过血行或直接侵入患者脊髓、脑血管、脑神经、脑实质、蛛网膜、软脑膜等部位，引发非化脓性炎症[1-2]。结核性脑膜炎是较为严重的肺外结核病，如果诊断、治疗不及时，极易引发严重不良后果[3]。既往有研究表明：获得性免疫缺陷综合征（AIDS）、恶性肿瘤、长期激素治疗、糖尿病、嗜酒、营养不良等均为结核性脑膜炎（TBM）的易感因素[4]。TBM患者早期临床症状不典型，随着病情的发生、发展，患者会出现脑膜刺激征及中枢神经系统症状，病情严重的患者会出现肢体截瘫、视力障碍、眼外肌麻痹、呼吸衰竭等，对其生命安全构成严重威胁[5]。……