Incidence and Risk Factors of Ophthalmic Nerve Palsy in Patients With Tuberculous Meningitis: A Retrospective Study and Literature Review.

IF 3.8 4区医学 Q2 IMMUNOLOGY Open Forum Infectious Diseases Pub Date : 2024-11-19 eCollection Date: 2024-12-01 DOI:10.1093/ofid/ofae686

Zhen-Tao Fei, Lu Xia, Yang Yang, Dan Ye, Hua-Rui Liu, Ping Liu, Wei Huang, Feng Li, Xu-Hui Liu

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Abstract

Background: Tuberculous meningitis (TBM) can lead to ophthalmic nerve palsy (ONP), a severe neurological complication. This study aims to evaluates the incidence and risk factors for ONP in TBM patients.

Methods: This retrospective study included 250 TBM patients from the Shanghai Public Health Clinical Center (2013-2022). Clinical and imaging data were analyzed, with logistic regression identifying risk factors for ONP.

Results: ONP occurred in 6.8% (17/250) of TBM patients. Those with ONP had higher intracranial pressure (ICP) (257.69 ± 68.12 mmH2O vs 191.65 ± 91.58 mmH2O; P = 0.012), cerebrospinal fluid protein levels, and a higher prevalence of tuberculomas (29.4% vs 10.7%; P = 0.039). Logistic regression identified pre-treatment ICP, CD4 percentage, and tuberculomas as significant risk factors. Linezolid use was a protective factor for ONP recovery.

Conclusions: Six point eight percent (17/250) of patients with TBM developed ONP as a complication. ICP, CD4 counts, and tuberculomas are key predictors. Linezolid shows potential as a therapeutic agent for improving outcomes in TBM patients with neurological complications, warranting further study.

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结核性脑膜炎患者眼神经麻痹的发生率及危险因素：回顾性研究及文献复习。

背景：结核性脑膜炎（TBM）可导致眼神经麻痹（ONP），一种严重的神经系统并发症。本研究旨在评估TBM患者ONP的发生率及危险因素。方法：回顾性研究上海市公共卫生临床中心2013-2022年收治的250例TBM患者。对临床和影像学资料进行分析，用逻辑回归确定ONP的危险因素。结果：TBM患者中ONP发生率为6.8%（17/250）。ONP组颅内压（ICP）较高(257.69±68.12 mmH2O vs 191.65±91.58 mmH2O；P = 0.012)，脑脊液蛋白水平，以及更高的结核瘤患病率(29.4% vs 10.7%；P = 0.039)。Logistic回归发现治疗前ICP、CD4百分比和结核瘤是显著的危险因素。利奈唑胺的使用是ONP恢复的保护因素。结论：6.8%（17/250）的TBM患者并发ONP。ICP、CD4计数和结核瘤是关键的预测因子。利奈唑胺有潜力作为一种治疗药物改善TBM患者神经系统并发症的预后，值得进一步研究。

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来源期刊

Open Forum Infectious Diseases Medicine-Neurology (clinical)

CiteScore

6.70

自引率

4.80%

发文量

630

审稿时长

9 weeks

期刊介绍： Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.