目的 分析儿童结核性脑膜炎（TBM）远期预后的危险因素，评价脑脊液（CSF）乳酸脱氢酶（LDH）对TBM 远期预后的预测价值。方法 回顾分析2013 年1 月—2019 年10 月住院TBM患儿的临床资料。结果 纳入88 例患儿，男48 例、女40 例，中位年龄7 . 5 岁（3 个月~ 14 岁）。其中27 例（30.7%）预后不良，包括12 例重度残疾及15 例死亡；61 例（69.3%）预后良好，包括45 例治愈，11 例轻度残疾，5 例中度残疾。与预后良好组相比，预后不良组年龄较小，临床分期为Ⅲ期、肢体瘫痪、惊厥、脑积水比例较高，LDH水平升高，差异均有统计学意义（P<0.05）。采用ROC曲线分析确定CSF 中LDH预测TBM预后不良的AUC为0.81（P< 0 . 001，95%CI ：0.71~0.88），LDH水平为103 U/L时，灵敏度为63.0%、特异度91.8%、约登指数0 . 548。多元logistic 回归分析发现，临床分期为Ⅲ期（OR=19 . 48，95%CI ：3 . 49~108 . 68）， LDH≥ 103 U/ L（OR=16 . 27，95%CI ：1 .16~227. 95）为TBM远期预后不良的独立危险因素；年龄越大，远期预后越好（OR=0.78，95%CI ：0.62~0.97）。结论 TBM远期预后不良的独立危险因素为临床Ⅲ期及CSF LDH≥ 103 U/L。CSF中LDH是TBM远期预后不良的有价值的预测因子。

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.