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           symptoms (fever,headache,disturbance of consciousness,cervical resistance),laboratory and imaging examination results
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           〔including prevalence of HIV infection,CD 4  T lymphocyte count,C-reactive protein,intracranial pressure and routine
           cerebrospinal fluid(CSF) biochemical markers (glucose,chlorine,protein and cell number)〕. The influencing factors of
           TM in the model group were identified using Multivariate Logistic regression,and were used to develop a diagnostic scoring system
           for TM with each factor rated according to its β coefficient. Then its predictive value for TM was tested using the receiver operating
           characteristic(ROC)curve. Results TM and non-TM patients in the model group had statistically significant differences in the
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           prevalence of headache and HIV infection,CD 4 T lymphocyte count less than 200/μl,elevated C-reactive protein,intracranial
           pressure greater than 200 mm H 2 O,decreased glucose and chlorine in CSF,elevated protein and monocytes in CSF(P<0.05).
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           Multivariate Logistic regression analysis revealed that headache,CD 4 T lymphocyte cell count less than 200/ μl,elevated
           C-reactive protein,decreased CSF glucose,and elevated CSF protein were associated with TM(P<0.05). Based on our clinical
           practical experience,CSF chlorine and monocytes were added in the multivariate Logistic regression,and further analysis found
                         +
           that headache,CD 4 T lymphocyte count less than 200/μl,elevated C-reactive protein,decreased CSF glucose,and elevated
           CSF protein were still the associated factors of TM(P<0.05). The clinical diagnostic scoring system for TM was developed using
           the aforementioned 7 factors with their values assigned based on the β coefficient value for scoring,among which the assigned
           value for decreased CSF was 1 point,and the assigned value for each of the other six factors was calculated using that of decreased
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           CSF multiplying the corresponding multiples. For the ease of clinical use,the assigned values for both headache and CD 4 T
           lymphocyte count less than 200/μl were increased by 2.5 points since the original assigned values of them were negative. The area
           under the curve(AUC) of the clinical diagnostic scoring system for TM in predicting TM in model group was 0.807〔95%CI
           (0.735,0.879),standard error=0.037,P<0.001〕with 21.50 points as the optimal cut-off value. And that of the system in
           predicting TM in the validation group was 0.766〔95%CI (0.610,0.921),standard error=0.079,P=0.004〕,with sensitivity of
           0.789 and specificity of 0.667. Conclusion The clinical diagnostic scoring system for TM developed using seven factors is simple
           and easy-to-use,which has proven to be effective in early diagnosis of TM.
               【Key words】 Tuberculosis,meningeal;Meningitis;Diagnosis;Clinical diagnostic scoring system;AIDS



               结核病作为一种常见传染病,是目前全球导致死                           断;诊断要点包括密切的结核接触史及是否接种卡介苗,
           亡的十大原因之一          [1] 。 结 核 性 脑 膜 炎(tuberculous     有肺部、泌尿生殖系统、肠道等结核病灶,发病缓慢,
           meningitis,TM)约占所有结核病的 1%,在肺外结核                     具有结核中毒症状,伴颅内高压、脑膜刺激征及其他神
           中 占 5%~10%  [2] 。 由 于 TM 起 病 较 隐 匿, 早 期 症 状         经系统症状和体征,脑脊液检查符合非化脓性脑膜炎表
           不典型,特异性检查较少,导致 TM 的误诊率较高。                           现,抗结核治疗有效;③结核分枝杆菌基因聚合酶链式
           即使 TM 患者接受了抗结核治疗,但仍有较高的病死                           反应(TB-DNA PCR)结合探针检测阳性及抗结核治疗
           率(10.0%~36.5%)   [3] , 尤 其 是 在 艾 滋 病(acquired       有效。符合 3 条中 1 条即可诊断。
           immune deficiency syndrome,AIDS)患者中,其临床表                排除标准:脑血管意外、糖尿病等引起的中枢神经
           现不典型造成了诊断延迟、抗结核治疗不及时,进而                             系统疾病。
           导致患者病死率、致残率高。因此,早期诊断、早期                             1.3 临床资料
           治疗对于改善 TM 患者的预后极为重要。本研究通过分                          1.3.1 一般资料 收集患者的一般资料,主要包括性别、
           析 TM 患者的临床症状、影像学检查、实验室检查等资                          年龄、临床症状(发热、头痛、意识障碍、颈抵抗)。
           料,建立 TM 临床诊断评分体系(tuberculous meningitis             1.3.2 实验室及影像学检查结果 整理患者相关实验室
           clinical diagnostic score,TMCDS),并对其应用价值进           检查及影像学检查结果,包括人类免疫缺陷病毒(HIV)
                                                                            +
           行初步评价。                                              感染情况、CD 4 T 淋巴细胞计数、C 反应蛋白、颅内压、
           1 对象与方法                                             脑脊液常规生化检查(糖、氯、蛋白、细胞数)等。
           1.1 研究对象 选取 2011 年 11 月至 2021 年 9 月在柳               1.4 判断标准 意识障碍包括嗜睡、昏睡、浅昏迷、
           州市人民医院感染病科住院并诊断为脑膜炎的患者 187                          中度昏迷、深昏迷,符合其中任一条即考虑为意识障碍;
           例为研究对象。本研究通过柳州市人民医院伦理委员会                            C 反应蛋白 >6 mg/L 即为 C 反应蛋白升高;脑脊液糖
           审核批准(KY2021-013-01),患者均签署知情同意书。                     <2.5 mmol/L 即为脑脊液糖降低;脑脊液氯 <120 mmol/L
           1.2 诊断及排除标准 诊断标准:(1)AIDS 的诊断                        考虑脑脊液氯降低;脑脊液蛋白 >0.45 g/L 即为脑脊液
           参照《中国艾滋病诊疗指南(2018 年版)》                [4] ;(2)      蛋白升高;脑脊液单核细胞比例 >50% 考虑为脑脊液单
           TM 诊断标准:①脑脊液结核菌涂片及培养阳性;②细                           核细胞升高。
           菌学阴性者需结合临床病史、体征、实验室检查综合判                            1.5 分组 采用 SPSS 21.0 统计软件将患者随机分成建
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