山东医药2025，Vol.65Issue(4)：16-20,5.DOI:10.3969/j.issn.1002-266X.2025.04.004
无神经系统症状/体征的肺结核合并结核性脑膜炎患儿早期临床特征分析
Analysis of early clinical characteristics in pediatric patients with pulmonary tuberculosis complicated with tuberculous meningitis without neurological symptoms or signs
摘要
Abstract
Objective To investigate the early clinical characteristics of pediatric patients with pulmonary tuberculo-sis(PTB)complicated with tuberculous meningitis(TBM)who exhibit no neurological symptoms or signs,in order to pro-vide a reference for clinical diagnosis and treatment.Methods A retrospective study was conducted on 84 pediatric pa-tients newly diagnosed and initially treated for PTB complicated with TBM.Patients were classified into two groups:those without neurological symptoms/signs(NS-PTB-TBM group,n=46)and those with neurological symptoms/signs(S-PTB-TBM group,n=38).Demographic characteristics,laboratory test results,and radiological findings were compared be-tween the groups.Multivariate Logistic regression analysis was used to identify the factors associated with the absence of neurological symptoms/signs in pediatric patients with PTB complicated with TBM.Results Compared with the S-PTB-TBM group,the NS-PTB-TBM group exhibited significantly higher proportions of patients aged≥10 years,cough,malnu-trition,white blood cell counts≥12×109/L,and elevated peripheral blood levels of C-reactive protein(CRP),lactic de-hydrogenase,globulin,and adenosine deaminase(ADA);conversely,albumin and high-density lipoprotein(HDL)lev-els were significantly lower in the NS-PTB-TBM group(all P<0.05).Radiological evaluations demonstrated higher positiv-ity rates for sputum/gastric aspirate Mycobacterium tuberculosis(MTB)smear and nucleic acid amplification tests in the NS-PTB-TBM group,alongside increased frequencies of centrilobular nodules,tree-in-bud signs,hilar/mediastinal lymph-adenopathy,and diffuse miliary changes,and with a lower incidence of calcification(all P<0.05).Multivariate Logistic regression analysis revealed cough,elevated CRP,and elevated ADA were independent factors for the absence of neurolog-ical symptoms/signs at initial diagnosis.Conclusions Pediatric patients with NS-PTB-TBM exhibit more active inflam-matory responses and distinct radiological features at initial diagnosis and treatment.Elevated peripheral blood CRP and ADA levels are independent risk factors for the absence of neurological symptoms or signs in these patients.关键词
肺结核/结核性脑膜炎/神经系统症状/早期诊断/儿童疾病Key words
pulmonary tuberculosis/tuberculous meningitis/neurological symptoms/early diagnosis/pediatric diseases分类
医药卫生引用本文复制引用
郑圣坤,黄绍梅,马尚明,郭慧莲..无神经系统症状/体征的肺结核合并结核性脑膜炎患儿早期临床特征分析[J].山东医药,2025,65(4):16-20,5.基金项目
广东省广州市卫生健康科技一般引导项目(20251A010030). （20251A010030）
