血行播散性肺结核合并颅内结核的临床特点.

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. [ABSTRACT FROM AUTHOR]