结核性脑膜脑炎继发缺血性脑卒中的临床特征及危险因素分析

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中图分类号：R529.3 文献标志码：A 文章编号：1001-8751（2025）02-0096-06

ClinicalCharacteristicsandRiskFactorsofTuberculous Meningitis-induced Ischemic Stroke

Xiong Lei，Li Tao，Jiang Min， Gao Yue-qin，Ge Yang（Public Health Clinical Center of Chengdu， Chengdu ）

Abstract：ObjectiveThegoal of this studyis to clarifythe clinical signsand risk factors of ischemic stroke， which isa consequence of tuberculous meningitis （TBM）.MethodsWeconducted a retrospective analysis of the clinical data and MRI findings of 156 patients with tuberculous meningitis （TBM）. Through univariate analysis， we explored the clinical characteristics of ischemic stroke as asecondary complication.Subsequently，weutilized binary logistic regression analysis to assessthe risk factors associated with the development of ischemic stroke as a secondary complication in TBM patients.ResultsAmong the 156 patients，there were 34 cases （21.79%） inthe ischemic stroke group and 122 cases （78.21%） ）in the non-ischemic stroke group；79 cases （50.64%） had been treated withregular HREZ anti-tuberculosis therapy before admission，while 77 cases （49.36%） ）had not. In comparison to the non-stroke group，patients inthe stroke group were more likely to exhibit meningeal iritation signs，meningeal enhancement in the basal cisterns and lateral fisures，and higher levels of lactate and adenosine deaminase （ADA） incerebrospinal fuid（CSF）during laboratory testing.Those who had notreceived anti-tuberculosis treatment before admission were fewer， and the differences were statistically significant （P<0.05） .Further multivariate logistic regression analysis revealed that not receiving regular HREZ anti-tuberculosis treatment before admission and meningeal enhancement in the basal cisterns were two independent risk factors for TBM secondary ischemic stroke （P<0.05） .ConclusionTBMpatients are at an increased risk of developing ischemic stroke.It is imperative for clinicians to maintaina high levelof vigilance forthe clinical manifestations ofTBM.The integrationof head MRI imaging with cerebrospinal fuid laboratorymarkers may facilitate earlydiagnosis.Initiating regularanti-tuberculosis therapy promptly can significantly lower the risk of ischemic stroke.

Key words： meningitis； tuberculous； magnetic resonance imaging； ischemic stroke； clinical manifestations；risk factors

中枢神经系统结核约占所有结核病（TB）病例的1% ，其中结核性脑膜脑炎（TBM）是最常见并且最具破坏性的表现之一[1-2]。（剩余6879字）