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目的探讨结核性脑膜炎的早期临床诊断。方法对210例结核性脑膜炎患者的早期诊断进行回顾性分析。结果临床症状典型191例,脑脊液常规、生化检查典型193例,涂片查抗酸杆菌阳性33例,结核抗体阳性82例,分枝杆菌PCR阳性73例,BAC培养阳性53例,颅脑MRI/CT异常发现134例。结论结核菌素试验、结核抗体检测对其诊断价值不大。及时开展脑脊液检查、血γ-干扰素释放试验、头颅MRI检查,完善脑脊液常规生化、结核细菌学、分枝杆菌PCR检查并综合分析,可提高早期诊断率。
Objective To investigate the early clinical diagnosis of tuberculous meningitis. Methods A retrospective analysis of 210 cases of tuberculous meningitis in patients with early diagnosis. Results Clinical symptoms were typical in 191 cases. Cerebrospinal fluid was routinely and biochemically examined in 193 cases. 33 cases were positive for smear-positive acid-fast bacillus, 82 cases were positive for tuberculosis, 73 cases were positive for mycobacteria PCR, 53 cases were positive for BAC, 134 cases of CT abnormalities were found. Conclusion tuberculin test, detection of tuberculosis antibody is of little value to its diagnosis. Timely cerebrospinal fluid examination, blood γ-interferon release test, cranial MRI examination, improve the conventional cerebrospinal fluid biochemistry, tuberculosis bacteriology, mycobacterium PCR examination and comprehensive analysis, can improve the early diagnosis rate.