目的 探讨小剂量地塞米松联合抗结核治疗结核性脑膜炎(tuberculous meningitis,TBM)合并2型糖尿病(type 2 diabetes mellitus,T2DM)的临床疗效.方法 将86例TBM合并T2DM患者,用随机数字表法分为两组,每组各43例.对照组采用常规剂量地塞米松联合抗结核治疗,观察组采用小剂量地塞米松联合抗结核治疗.比较两组临床疗效、症状消失时间、脑脊液生化、血糖稳态、白介素(interleukin,IL)-33、腺苷脱氨酶(adenosine deaminase,ADA)水平以及不良反应.结果 两组治疗总有效率、脑脊液生化、脑脊液IL-33及ADA水平比较,差异无统计学意义(P＞0.05).与治疗前相比,对照组空腹血糖、空腹胰岛、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)以及糖化血红蛋白水平增高,差异有统计学意义(P＜0.05),而观察组治疗后差异无统计学意义(P＞0.05).观察组症状消失时间较对照组长,且不良反应发生率低于对照组(P＜0.05).结论 小剂量地塞米松联合抗结核治疗结核性脑膜炎合并2型糖尿病患者,可稳定血糖,降低脑脊液IL-33、ADA水平及不良反应.
Application value of low-dose dexamethasone in tuberculous meningitis with type 2 diabetes
Objective To investigate the clinical effect of low-dose dexamethasone combined with anti-tuberculosis therapy on tuberculous meningitis(TBM)complicated with type 2 diabetes mellitus(T2DM).Methods 86 TBM patients with T2DM were divided into two groups by random number table method,with 43 cases in each group.The control group was treated with conventional dose dexamethasone combined with anti-tuberculosis therapy,and the observation group was treated with low-dose dexamethasone combined with anti-tuberculosis therapy.The clinical efficacy,duration of symptom resolution,cerebrospinal fluid biochemistry,blood glucose homeostasis,interleukin-33(IL-33)and adenosine deaminase(ADA)levels and adverse reactions were compared between the two groups.Results There were no significant differences in the total effective rate,cerebrospinal fluid biochemistry,cerebrospinal fluid IL-33 and ADA levels between the two groups(P＞0.05).Compared with before treatment,fasting blood glucose,fasting islet,insulin resistance index(homeostasis model assessment of insulin resistance,HOMA-IR)and glycosylated hemoglobin levels in control group were increased,and the differences were statistically significant(P＜0.05),while there was no significant difference in observation group after treatment(P＞0.05).Symptom disappearance time in observation group was longer than that in control group,and the incidence of adverse reactions was lower than that in control group(P＜0.05).Conclusion Low-dose dexamethasone combined with anti-tuberculosis treatment for TBM patients with T2DM can stabilize blood sugar,reduce the levels of IL-33 and ADA in cerebrospinal fluid and adverse reactions.
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