小孩結核性腦膜炎的臨床觀察與分析

Clinical Analysis of Tuberculous Meningitis in Children

黃焜璋(Kung-Chang Hwang) ； 李慶雲(Chin-Yun Lee) ； 沈友仁(Yu-Zen Shen)

《Acta Paediatrica Sinica》 19卷2期 (1978/06) Pp. 158-167

摘要

自民國61年7月至66年6月，因結核性腦膜炎住進臺大醫院小兒科的病人共55例，男孩有35人，女孩有20人，病人的年齡最小爲3個月大，最大爲15歲，半數的病例年齡在2歲以下。55例中與結核病人有明顯接觸者有30例(55%)；54例接受胸部X光檢查，41例(76%)顯示肺結核；51例皮膚結核菌素試驗中，反應陽性者33例(65%)；51例腦脊髓液中，培養出結核菌者有17例(33.3%)。病人接受治療後，主要徵狀及檢查的改善，依序爲嘔吐、頭痛、抽搐及發燒、意識障礙、頸部僵硬等的改善，再接著爲腦脊髓液糖份恢復正常，而腦脊髓液蛋白質及白血球數之改善常需要2個月以上的時間。
55例中有12例未能在本院繼續治療及追踪，其餘之43例，死亡13例(30%)，有神經系統之後遺症者18例(42%)，而完全康復者12例(28%)。治療的結果，與病人來住時的臨床狀況有關，9例第三期才來的病人，死亡5例(56%)，其餘4例亦都併有神經系統的後遺症。病人的年齡也是一項重要的因素，1歲以內的病例死亡率偏高；而5歲以上的病例則有較高的治愈率。此外有明顯的水腦出現或腦脊髓液之蛋白質濃度偏高者，死亡率亦較高。

並列摘要

Fifty-five cases of tuberculous meningitis were admitted to the Pediatric Department of the National Taiwan University Hospital from June 1972 to July 1977. The ratio of male to female was 35:20 and age distribution was from 3 months to 15 years. Forty-nine percent of the patients were below age of 2 years.
Fifty-four cases received chest X-ray examinations and 41 (76%) of them revealed pulmonary tuberculosis. PPD test was performed in 51 cases, and 33 (65%) of them were PPD positive. There were 51 cerebrospinal fliid specimens sent for TB culture and TB bacilli were isolated from 17 (33%) of them. Positive contact history with tuberculous patients could be obtained in 30 cases (55%).
The major clinical manifestations were fever, neck stiffness, drowsiness, vomiting, headache and convulsion. The disappearance of symptoms and signs was in the order of vomiting, headache, convulsion, drowsiness, fever and neck stiffness. Together with the clinical improvement, the first sign of laboratory improvement was the rise of cerebrospinal fluid sugar. However, cerebrospinal fluid protein and cell count did not always show improvement in the same time.
Among the 55 cases, four patients voluntarily discharged against medical advice; five were lost during the follow- up period although they were discharged in an improved condition; Three were transferred to another hospital in an improved condition and were not followed up at our clinic. Of the remaining 43 cases, 13 (30%) died, 18 (42%) had significant neurologic sequelae and only 12 (28%) recovered completely. The outcome depended upon the clinical state at admission. Of 9 patients who were grouped in clinical stage III at admission, 5 (56%) died, the remainder all had neurologic sequelae. Morbidity and mortality were inversely related to the age of patient. Poor outcome was always associated with hydrocephalus and high protein content in cerebrospinal fluid.

並列關鍵字

tuberculous meningitis ； CSF ； fatality rate