涉及大脑的大型结核质病变:结果和管理
Prasannakumar Palanikumar1, Priyanka Gautam1, Harshad Arvind Vanjare2
1Department of Infectious Diseases, Christian Medical College, Vellore, India.
The American journal of tropical medicine and hygiene
|April 1, 2025
概括
对于中枢神经系统大结核质病变 (LTML) 的最佳管理尚不清楚. 这项研究发现,在抗结核疗法 (ATT) 中添加类固醇或手术并没有显著改善患者的治疗结果.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 中枢神经系统结核病 (CNS TB) 可以表现为大型结核质病变 (LTML),造成管理挑战.
- 对于LTML的最佳治疗策略,包括结核瘤和结核 ≥3厘米,需要进一步阐明.
研究的目的:
- 评估对中枢神经系统大结核质病变 (LTML) 患者的不同管理策略的结果.
- 评估单独使用抗结核疗法 (ATT) 与ATT与类固醇或外科手术结合对患者功能独立性的影响.
主要方法:
- 一项回顾性,单中心的观察性研究包括了46名在2010年1月至2023年2月期间被诊断患有LTML的患者.
- 在6个月的随访中,使用修改的兰金度量表 (mRS) 评估了结果,重点是日常生活活动中的独立性.
- 治疗组包括单独使用ATT,使用类固醇ATT,使用手术ATT以及使用类固醇和手术ATT.
主要成果:
- 仅使用ATT的患者中有76.9%,使用ATT和类固醇的患者有62.5%,使用ATT和手术的患者有87.5%,使用ATT,类固醇和手术的患者有66.9%.
- 所有患者的mRS中位数从基线时的2个改善到6个月后的1个.
- 在ATT中添加类固醇或手术并没有在主要结局中产生统计学上显著的改善 (P=0.637).
结论:
- 单独使用抗结核疗法 (ATT) 似乎是治疗中枢神经系统大结核质病变 (LTML) 的可行选择.
- 目前的证据并不强烈支持在LTML中改善功能结果的ATT常规添加类固醇或手术干预.
- 需要进行更大规模的前性研究,以最终确定CNS LTML的最佳管理模式.
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