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【文摘发布】观察性研究：连续MRI观察地塞米松
Author: Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, White NJ, Tran TH, Summers D, Farrar JJ.
Resourse: Lancet Neurol. 2007 Mar;6(3):230-6.
BACKGROUND: Adjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear. We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treated for tuberculous meningitis. METHODS: Cerebral MRI was undertaken, when possible, at diagnosis and after 60 days and 270 days of treatment in adults with tuberculous meningitis admitted to two hospitals in Vietnam. Patients were randomly assigned either dexamethasone (n=24) or placebo (n=19) and received 9 months of treatment with standard first-line antituberculosis drugs. We assessed associations between MRI findings, treatment allocation, and resolution of fever, coma, cerebrospinal fluid inflammation, and neurological outcome. FINDINGS: 83 scans were done for 43 patients: 19 given placebo, 24 given dexamethasone. Basal meningeal enhancement (82%) and hydrocephalus (77%) were the most common presenting findings. Fewer patients had hydrocephalus after 60 days of treatment with dexamethasone than after placebo treatment (p=0.217). Tuberculomas developed in 74% of patients during treatment and in equal proportions in the treatment groups; they were associated with long-term fever, but not relapse or poor clinical outcome. The basal ganglia were the most common site of infarction; the proportion with infarction after 60 days was halved in the dexamethasone group (27%vs 58%, p=0.130). INTERPRETATION: Dexamethasone may affect outcome from tuberculous meningitis by reducing hydrocephalus and preventing infarction. The effect may have been under-estimated because the most severe patients could not be scanned.
PMID: 17303529 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Title: Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study.
标题：一项观察性研究：通过连续MRI检测来确定地塞米松对结核性脑炎中枢病变的疗效
Author: Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, White NJ, Tran TH, Summers D, Farrar JJ.
作者：Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, White NJ, Tran TH, Summers D, Farrar JJ.
Resourse: Lancet Neurol. 2007 Mar;6(3):230-6.
文章来源：柳叶刀神经病学杂志.2007.3月; 6(3):230-6
BACKGROUND: Adjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear.
背景：
使用地塞米松辅助治疗可以增加结核性脑膜炎的存活率，但其作用机制还不清楚。
We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treated for tuberculous meningitis.
我们的目的是确定地塞米松在治疗成人结核性脑膜炎中对大脑MRI变化的作用，及其与脑内炎症应答的关系和临床效果。
METHODS: Cerebral MRI was undertaken, when possible, at diagnosis and after 60 days and 270 days of treatment in adults with tuberculous meningitis admitted to two hospitals in Vietnam.
方法：对越南两家医院的结核性脑膜炎入院成人患者，若条件允许，在收诊时和治疗后60天，270天进行大脑MRI扫描检测。
Patients were randomly assigned either dexamethasone (n=24) or placebo (n=19) and received 9 months of treatment with standard first-line antituberculosis drugs.
患者被随机分成两组，一组给予地塞米松(n=24)，一组给予安慰剂(n=19)，同时接受9个月的一线标准抗结核药治疗。
We assessed associations between MRI findings, treatment allocation, and resolution of fever, coma, cerebrospinal fluid inflammation, and neurological outcome.
我们评估MRI检测结果，治疗分组，与发热，昏迷，脑脊液发炎症状减退，及神经学结果间的联系。
FINDINGS: 83 scans were done for 43 patients: 19 given placebo, 24 given dexamethasone. Basal meningeal enhancement (82%) and hydrocephalus (77%) were the most common presenting findings.
结果：对43名患者进行了83项扫描：19名给予安慰剂，24名给予地塞米松。基底脑膜强化(82%)及脑积水(77%)是最常出现的结果。
Fewer patients had hydrocephalus after 60 days of treatment with dexamethasone than after placebo treatment (p=0.217).
治疗60天后，地塞米松组的脑积水患者比安慰剂组少 (p=0.217)。
Tuberculomas developed in 74% of patients during treatment and in equal proportions in the treatment groups; they were associated with long-term fever, but not relapse or poor clinical outcome.
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作者:admin@医学,生命科学 2011-02-27 05:11
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