天津医药

天津医药 ›› 2024, Vol. 52 ›› Issue (5): 495-498.doi: 10.11958/20231092

• 临床研究 • 上一篇    下一篇

血行播散性肺结核合并颅内结核的临床特点

邵红霞1,2,3(), 吴涓涓4, 于洪志1,2,3, 吴琦3,5, 武俊平1,2,△()   

  1. 1 天津大学海河医院（邮编300350）
    2 国家中医药管理局中医药防治传染病重点研究室
    3 天津市呼吸疾病研究所
    4 天津医科大学海河临床学院
    5 天津医科大学总医院
  • 收稿日期:2023-07-18 修回日期:2023-08-25 出版日期:2024-05-15 发布日期:2024-05-09
  • 通讯作者: △ E-mail：wujp0618@126.com
  • 作者简介:邵红霞（1983），女，主任医师，主要从事感染相关方面研究。E-mail：shaohxlil@126.com
  • 基金资助:
    天津市医学重点学科（专科）建设项目(TJYXZDXK-067C);天津市卫生健康科技项目(TJWJ2022XK035);天津市科技计划项目(22JCYBJC00730);天津市津门医学英才项目(TJSJMYXYC-D2-012)

Clinical features of hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis

SHAO Hongxia1,2,3(), WU Juanjuan4, YU Hongzhi1,2,3, WU Qi3,5, WU Junping1,2,△()   

  1. 1 Haihe Hospital, Tianjin University, Tianjin 300350, China
    2 TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine
    3 Tianjin Institute of Respiratory Diseases
    4 Haihe Clinical College of Tianjin Medical University
    5 Tianjin Medical University General Hospital
  • Received:2023-07-18 Revised:2023-08-25 Published:2024-05-15 Online:2024-05-09
  • Contact: △ E-mail：wujp0618@126.com

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摘要：

目的 分析血行播散性肺结核合并颅内结核的临床特点，以提高临床医生的诊断意识。方法 选取341例血行播散性肺结核患者，其中83例合并颅内结核。收集并分析患者的性别、年龄、既往史、临床表现；痰抗酸杆菌涂片、痰结核分枝杆菌培养、痰结核分枝杆菌/利福平耐药实时荧光定量核酸扩增技术（X-pert）；颅内压，脑脊液常规、生化，脑脊液抗酸杆菌涂片、结核分枝杆菌培养、X-pert；血常规、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、白蛋白、C反应蛋白、红细胞沉降率、结核抗体、结核感染T细胞检测（T-SPOT）)；胸部CT平扫、头颅CT平扫及增强扫描、头颅MRI平扫及增强扫描检查结果。结果 83例合并颅内结核患者的症状以发热（74例）、头痛（53例）为主，11例合并糖尿病，9例使用激素/免疫抑制剂，4例合并妊娠/分娩/流产，6例合并腹腔结核，6例合并骨关节结核，2例生殖系统结核，1例淋巴结结核，1例泌尿系统结核，1例口腔黏膜结核。49例血钠降低（<135 mmol/L），平均131.0（126.2，135.8）mmol/L。44例患者的脑脊液蛋白质≥1 g/L，37例患者的脑脊液葡萄糖水平<2.2 mmol/L，25例患者的脑脊液腺苷脱氨酶（ADA）≥6 U/L。83例患者均行胸CT检查，64例显示粟粒性结节，33例表现为单纯急性血行播散性肺结核，21例表现为单纯亚急性和慢性血行播散性肺结核，29例合并继发性肺结核。34例患者行头颅CT检查，其中梗死灶10例，结核瘤4例，脑积水1例。51例行头颅MRI检查，其中脑基底部脑膜强化10例，脑梗死灶7例，结核瘤4例。结论 充分评估血行播散性肺结核患者的年龄、症状、头胸部影像学、脑脊液、血钠等有助于诊断颅内结核。

关键词: 结核, 中枢神经系统, 脑脊髓液, 诊断, 鉴别, 血行播散性肺结核, 头颅影像学

Abstract:

Objective To analyze the clinical characteristics of hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis in order to improve the diagnostic consciousness of clinicians. Methods A total of 341 patients with hematogenous disseminated pulmonary tuberculosis were included in this study, and 83 cases of them were hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis. Clinical data of patient gender, age, past-history and symptoms were collected and analyzed. Sputum acid fast staining, sputum mycobacterium tuberculosis culture, sputum gene X-pert Mtb/RIF were performed. Intracranial pressure, cerebrospinal fluid routine and biochemistry, cerebrospinal fluid acid fast staining, mycobacterium tuberculosis culture and Xpert were performed. Blood routine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, C-reactive protein, erythrocyte sedimentation rate, tuberculosis antibody, tuberculosis T cell spot test (T-SPOT) were performed. Chest CT scan, head CT scan and contrast-enhanced scan, head MRI scan and enhanced scan were performed. Results The main symptoms of 83 patients with intracranial tuberculosis were fever (74 cases) and headache (53 cases). Eleven patients were combined with diabetes mellitus, and 9 cases were treated with hormone/immunosuppressive agents. There were 4 cases combined with pregnancy/childbirth/abortion, and 6 cases with abdominal tuberculosis. Six cases were combined with osteoarticular tuberculosis, 2 cases with reproductive system tuberculosis, 1 case with lymph node tuberculosis, 1 case with urinary system tuberculosis, and 1 case with oral mucosa tuberculosis. Serum sodium was decreased (< 135 mmol/L) in 49 cases, and the mean serum sodium was 131.0 (126.2, 135.8) mmol/L. Cerebrospinal fluid (CSF) protein levels were ≥1 g/L in 44 patients, CSF glucose levels were < 2.2 mmol/L in 37 patients, and CSF adenosine deaminase (ADA) levels were ≥6 U/L in 25 patients. All 83 patients underwent chest CT examination, and 64 cases showed miliary nodules, 33 cases showed simple acute hematologic disseminated pulmonary tuberculosis. Subacute and chronic hematologic disseminated pulmonary tuberculosis were found in 21 cases, and 29 cases were combined with secondary pulmonary tuberculosis. Among them, 34 patients underwent head CT examination, and result showed infarction in 10 cases, tuberculoma in 4 cases and hydrocephalus in 1 case. Brain MRI was performed in 51 cases, including 10 cases of enhanced meninges in the basal part of brain, 7 cases of cerebral infarction and 4 cases of tuberculoma. Conclusion Fully assessment of age, symptoms, chest CT, head imaging, cerebrospinal fluid, serum sodium of patients with hematopoietic tuberculosis is helpful for the diagnosis of intracranial tuberculosis.

Key words: tuberculosis, central nervous system, cerebrospinal fluid, diagnosis, differential, hematogenous disseminated pulmonary tuberculosis, cranial imaging

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