[Clinical features and influencing factors of long-term prognosis in patients with tuberculous meningitis].

Objective: To investigate the clinical features and influencing factors of long-term prognosis of tuberculous meningitis(TBM), and to provide a recommendation for treatment and early intervention of TBM. Methods: Clinical data of TBM patients were retrospectively collected at Peking Union Medical College Hospital from January 2014 to December 2021. Patients who were followed-up more than one year were divided into two groups according to modified Rankin Scale (mRS). Risk factors associated with long-term prognosis were analyze by conditional logistic stepwise regression. Results: A total of 60 subjects were enrolled including 33 (55%) males and 27 (45%) females with age 15-79 (44.5±19.8) years. There were 30 cases (50%) complicated with encephalitis, 21 cases (35%) with miliary tuberculosis. The diagnosis was microbiologically confirmed in 22 patients (36.7%), including 5 cases (22.7%, 5/22) by acid-fast staining, 8 cases (36.4%, 8/22) by Mycobacterium tuberculosis (MTB) culture, and 20 cases (90.9%, 20/22) by molecular biology. The median follow-up period was 52(43, 66 ) months in 55 cases surviving more than one year. Among them, 40 cases (72.7%) were in favorable group (mRS 0-2) and 15 cases (27.3%) were in unfavorable group (mRS 3-6) with poor prognosis. The mortality rate was 20% (11/55). Elderly (OR=1.06, P=0.048 ) , hyponatremia(OR=0.81,P=0.020), high protein level in cerebrospinal fluid (CSF) (OR=3.32,P=0.033), cerebral infarction(OR=10.50,P=0.040) and hydrocephalus(OR=8.51,P=0.049) were associated with poor prognosis in TBM patients. Conclusions: The mortality rate is high in patients with TBM. Molecular biology tests improves the sensitivity and shorten the diagnosis time of TBM. Elderly, hyponatremia, high protein level in CSF, cerebral infarction and hydrocephalus are independent risk factors of long-term survival in TBM patients.目的： 分析结核性脑膜炎（tuberculous meningitis，TBM）患者临床特征和远期预后的影响因素，为其临床诊治和早期干预提供依据。 方法： 回顾性分析北京协和医院2014年1月至2021年12月60例出院诊断为TBM患者的临床资料。随访1年以上患者根据其预后情况分为预后良好组和预后不良组，采用logistic回归分析影响两组患者远期预后的相关因素。 结果： 60例TBM患者，男性33例（55%），女性27例（45%），年龄15~79（44.5±19.8）岁，30例（50%）合并脑炎，21例（35%）存在结核播散感染，病原学确诊22例（36.7%），其中22.7%（5/22）抗酸染色阳性，36.4%（8/22）结核分枝杆菌（Mycobacterium tuberculosis，MTB）培养阳性，90.9%（20/22）分子生物学阳性。55例患者随访1年以上，中位随访时间52（43，66）个月，预后良好40例（72.7%），预后不良15例（27.3%），死亡11例，病死率20%。高龄（OR=1.06，P=0.048）、低钠血症（OR=0.81，P=0.020）、脑脊液蛋白含量高（OR=3.32，P=0.033）、急性期脑梗死（OR=10.50，P=0.040）、脑积水（OR=8.51，P=0.049）是影响TBM远期预后的独立危险因素。 结论： TBM患者病死率高，分子生物学检测可提TBM诊断的敏感度并有效缩短诊断时间。高龄、低钠血症、脑脊液蛋白含量高、急性期脑梗死、脑积水是影响TBM远期预后的独立危险因素。.