背景：睫状结核（TB）是结核病最严重的表现之一，当伴有中枢神经系统（CNS）受累时可能致命。细菌学,在这项研究中,我们评估了生化和放射学方法,以发现在沙粒性TB中的CNS合并症.
方法：回顾性地从中国两家指定的结核病医院中纳入连续的恶性结核病成年人。脑脊液（CSF）的检查能力，评估了诊断中枢神经系统受累的脑计算机断层扫描(CT)和磁共振成像(MRI).
结果：在392例急性粟粒性结核病中，有282例进行了腰椎穿刺和/或神经影像学检查的中枢神经系统受累评估。在这282名患者中，87.59%(247/282)有中枢神经系统受累。脑增强MRI（96.05%，170/177）和MRI（93.15%，204/219）的敏感度明显高于脑脊液检查（71.92%，146/203,P<0.001)和CT(34.69%,17/49,P<0.001)。脑脊液检查的敏感性优于CT扫描（P<0.001）。尽管59.65%(134/225)的粟粒性结核病患者通过痰液检查获得了细菌学证据，常规和分子检测脑脊液检查阳性率仅为8.82%(21/238)。
结论：几乎所有的粟粒性结核都有中枢神经系统受累，MRI表现出优于其他方法的潜力。因此,应强烈建议在具类结核中常规筛查CNSTB,在资源丰富的环境中,MRI可作为初始方法.
BACKGROUND: Miliary tuberculosis (TB) is one of the severest manifestations of TB that can be lethal when concomitant with the central nervous system (CNS) involvement. Bacteriological, biochemical and radiological methods for find CNS comorbidity in
miliary TB was evaluated in this study.
METHODS: Consecutive
miliary TB adults were retrospectively enrolled from two designated TB hospitals in
China. The capacities of examinations of cerebrospinal fluid (CSF), cerebral computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis of CNS involvement were assessed.
RESULTS: Assessment of CNS involvement with a lumbar puncture and/or neuroimaging was undertaken in 282 out of 392 of acute miliary TB. Of these 282 patients, 87.59% (247/282) had CNS involvement. Cerebral contrast-enhanced MRI (96.05%, 170/177) and MRI (93.15%, 204/219) yielded significantly higher sensitivities over CSF examination (71.92%, 146/203, P < 0.001) and CT (34.69%, 17/49, P < 0.001). The sensitivity of CSF examination was superior to CT scan (P < 0.001). Although 59.65% (134/225) miliary TB patients acquired bacteriological evidence with sputum examination, the positivity was only 8.82% (21/238) for CSF examination by conventional and molecular tests.
CONCLUSIONS: Almost all miliary TB had CNS involvement and MRI demonstrated outstanding potential over other methods. Therefore, a routinely screening of CNS TB should be strongly suggested in
miliary TB and MRI could be used as the initial approach in resources rich settings.
