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结核性脑膜炎是一种较为严重的肺外结核病,其早期诊断困难,病死率和致残率高。由于脑脊液中抗酸染色和结核分枝杆菌培养阳性率低,脑脊液改良抗酸染色技术、免疫诊断技术和分子生物学技术(如Gene Xpert)受到重视。结核性脑膜炎的治疗依然是化学治疗为主,其方案依旧以异烟肼、利福平和吡嗪酰胺为核心,疗程建议12个月,部分病例可延长至18个月。高颅内压的治疗主要以脱水剂为主,可多种脱水剂联合应用,激素在改善生存率和临床症状上的价值明确,但对致残率的改善无明显作用。
Tuberculous meningitis is a more serious extra-pulmonary tuberculosis, its early diagnosis is difficult, mortality and disability rate. Due to the low positive rates of acid-fast staining and mycobacterial cultures in cerebrospinal fluid, improved techniques of acid-fast staining of cerebrospinal fluid, immunodiagnostic techniques and molecular biology techniques such as Gene Xpert are gaining prominence. The treatment of tuberculous meningitis is still the main chemotherapy, the program is still to isoniazid, rifampin and pyrazinamide as the core, treatment recommended for 12 months, some cases can be extended to 18 months. The treatment of high intracranial pressure is mainly dehydrating agent, which can be used in combination with various dehydrating agents. The value of hormone in improving the survival rate and clinical symptoms is clear, but it has no obvious effect on the improvement of the disability rate.