关键词: 结核性脑膜炎； 远期预后； 乳酸脱氢酶； 预测价值

Abstract: Objective To analyze the risk factors of the long-term prognosis of tuberculous meningitis (TBM) in children, and to evaluate the predictive value of cerebrospinal fluid (CSF) lactate dehydrogenase (LDH) on the long-term prognosis of TBM. Methods The clinical and follow-up data of TBM children admitted between January 2013 to October 2019 were retrospectively analyzed. Results A total of 88 children were included, including 48 boys and 40 girls, with a median age of 7.5 years ( 3 months to 14 years). Twenty-seven of the 88 patients ( 30 . 7 %) had poor prognosis, including 12 cases complicated with severe disability and 15 deaths. In contrast, 61 cases ( 69 . 3 %) had a good prognosis, including 45 cases cured, 11 children with mild disability and 5 children with moderate disability. Univariate analysis showed that the long-term prognosis was associated with younger age, clinical status at the stage III, limb paralysis, convulsion, significantly increased LDH level and hydrocephalus (all P< 0 . 05 ). The area under the curve was 0 . 81 (P< 0 . 001, 95 %CI : 0 . 71 - 0 . 88 ) to predict poor prognosis. When CSF LDH cut-off value ≥ 103 U/L, ROC curve analysis showed that the sensitivity and specificity of the long-term adverse prognosis were 63 . 0 % and 91 . 8 %. Multivariate logistic regression analysis showed that clinical status at the stage III (OR=19.48, 95%CI: 3. 49 - 108. 68 ) and LDH ≥ 103 U/L (OR= 16 . 27 , 95 %CI: 1 . 16 - 227 . 95 ) were independent risk factors for poor long-term prognosis of TBM (all P< 0 . 05 ). Conclusions The independent risk factors for long-term poor prognosis of TBM were clinical status at the stage III and CSF LDH ≥ 103 U/L. CSF LDH is a valuable predictor of long-term poor prognosis in TBM.

Key words: tuberculous meningitis; long-term prognosis; lactate dehydrogenase; predictive value