结核性脑膜炎（TBM）是由结核分枝杆菌（Mtb）感染引起的脑膜非化脓性炎症，发病隐匿、临床表现特异性差、预后差，是肺外结核病中病死率最高的类型。TBM发病机制复杂多样，主要是由于机体原发性免疫应答不足或继发性免疫功能缺陷，Mtb穿透血脑屏障播散所致。由于早期临床症状及常规检验结果不典型，Mtb培养敏感性低，早期诊断TBM很困难。随着临床诊治技术的不断进步，全自动Mtb/利福平耐药核酸扩增检测和高通量测序等检测技术已广泛应用，免疫学检测和多组学检测技术持续发展，新型抗Mtb药物以及综合治疗方案的临床使用，提高了TBM确诊率，减少了其并发症和后遗症的发生。本文就目前TBM相关诊断、治疗及研究新进展进行综述。

Tuberculous meningitis (TBM) is a non-suppurative meningeal inflammation caused by Mycobacterium tuberculosis (Mtb) infection, characterized by insidious onset, poor specificity in clinical manifestations and poor prognosis, making it the type of extrapulmonary tuberculosis with the highest mortality rate. The pathogenesis of TBM is complex and diverse, primarily resulting from insufficient primary immune response or secondary immune deficiency of the body, leading to Mtb penetration through the blood-brain barrier and dissemination. Due to the atypical early clinical symptoms and conventional test results, as well as the low sensitivity of Mtb culture, early diagnosis of TBM is difficult. Recent advances in clinical testing and treatment have greatly improved, automated real-time nucleic acid amplification detection for Mtb and Rifampicin resistance and high-throughput sequencing technologies have been widely adopted, immunological and multi-omics detection techniques continue to advance, and novel anti-tuberculosis drugs along with comprehensive treatment regimens are now in clinical use. These integrated diagnostic and therapeutic approaches have significantly improved the clinical confirmation rate of TBM while reducing the complications and sequelae. This article reviews the current advances in diagnosis, treatment and research of TBM.