恶性实体肿瘤脑膜转移的临床特点及诊断  

Leptomeningeal metastases in malignant solid tumors： clinical manifestations and diagnosis

作　　者：潘振宇[1] 杨国姿[1] 何华[2] 袁婷婷[3] 李钰[1] 董丽华[1] 

机构地区：[1]吉林大学第一医院放疗科,长春130021 [2]吉林大学第一医院肿瘤中心 [3]吉林大学第一医院放射科

出　　处：《中华神经科杂志》2015年第4期312-317,共6页Chinese Journal of Neurology

摘　　要：目的通过综合分析实体瘤脑膜转移的临床特点、神经影像学表现、脑脊液细胞学检查结果，提高对实体瘤脑膜转移的认识程度，寻找有效的检查方法及诊断策略。方法回顾性分析2009-2014年我院收治的94例恶性实体肿瘤脑膜转移患者临床表现、神经影像学及脑脊液细胞学检查资料；比较不同病理类型脑膜转移患者的临床表现及辅助检查结果，采用卡方检验进行统计学分析。结果患者病理类型分为：腺癌（61例）、小细胞癌（24例）、鳞癌（6例）、大细胞癌（1例）、黑色素瘤（1例）、肝细胞癌（1例）；中位年龄58（37～75）岁；中位Kamofsky功能状态评分40（10。80）分。98．9％（93／94）的患者具有相关神经系统症状。84例患者行影像学检查，敏感度为88．1％（74／84）。85例患者行脑脊液细胞学检查，敏感度为88．2％（75／85）。85例行脑脊液生化检查，敏感度为90．6％（77／85）。腺癌细胞学敏感度（96．6％，56／58）高于小细胞癌（80％，16／20），P=0．056；小细胞癌影像学敏感度（95．8％，23／24）高于腺癌（83．3％，45／52），P=0．409；鳞癌细胞学及影像学敏感度均低，诊断需要综合分析。腺癌及小细胞癌患者的头痛及脊神经症状、室管膜瘤强化及椎管内种植转移发生率分别为88．5％（54／61）及29．2％（7／24），P〈0．01；18．0％（11／61）及45．8％（11／24），P=0．008；2／6及25．0％（6／24），P=0．017；1．9％（1／61）及50．0％（12／24），P〈0．01，差异均具有统计学意义。结论神经影像检查及脑脊液检查仍是恶性实体瘤脑膜转移的主要诊断依据。患者的临床特征与原发肿瘤病理类型具有一定相关性。Objective To improve the understanding of leptomeningeal metastasis （LM）, we analyzed the data of clinical manifestations, imaging findings and cytological analysis of cerebrospinal fluid （CSF） in a group of patients with LM of malignant solid tumors. Methods The clinical data of 94 patients with LM of malignant solid tumors between 2009 and 2014 in our hospital were retrospectively analyzed. We compared the clinical manifestations and auxiliary examinations of patients with different pathological types of LM. The Chi-square test was used to compare the results. Results The pathological types included （61）, small cell carcinoma （ 24）, squamous carcinoma （ 6 ）, melanoma （ 1 ）, large-cell carcinoma （1）, and hepatocellular carcinoma （1）. The median age was 58 （37 -75 ） and the median KPS score was 40 （ 10 - 80 ）. About 98.9% （ 93/94 ） patients had neurologic symptoms. Neuroimaging examination was performed in 84 patients, with the sensitivity of 88.1% （74/84） ; cytological analysis of CSF was performed in 85 patients, with the sensitivity of 88.2% （75/85）; while CSF biochemical examination was performed in 85 patients, with the sensitivity of 90. 6% （77/85）. The sensitivity of cytology in adcnocarcinoma （96. 6%, 56/58 ） was higher than those in small cell carcinoma （80%, 16/20; P = 0. 056）. The sensitivity of neuroimaging in small cell carcinoma （95.8%, 23/24） was higher than that in adenocarcinoma （ 83.3%, 45/52; P = 0. 409 ） . However, the sensitivity of cytology （ 1/5 ） and neuroimaging （4/6） in squamous carcinoma was low, which led to the need of comprehensive analysis for the diagnosis. The incidence of headache, spinal nerve-related symptoms, ependymal enhancement and metastatic nodules of lumbosacral intraspinal in adenocarcinoma and small cell carcinoma showed statisticallysignificant difference, which was 88.5% （54/61） and 29. 2% （7/24; P 〈 0. 01 ）, 18.0% （ 11/61 ） and 45.8% （11/24; P=0.008）, 2/6 and 25.0% （6

关 键 词：脑膜肿瘤 肿瘤转移 癌 小细胞 腺癌 神经成像 细胞诊断学 

分 类 号：R739.45[医药卫生—肿瘤]