飞行人员大脑胶质瘤病1例及文献分析  

Analysis of a case of aircrew with gliomatosis cerebri

作　　者：王高卿[1] 刘红巾[1] 

机构地区：[1]空军总医院全军临床航空医学中心,北京100142

出　　处：《空军医学杂志》2015年第3期144-146,共3页Medical Journal of Air Force

摘　　要：目的探讨飞行人员患罕见病脑胶质瘤病(gliomatosis cerebri,GC)的发病机制、诊断、治疗,分析恶性肿瘤与飞行的关系及健康鉴定。方法分析1例飞行人员的临床资料及复习相关文献。结果本例亚急性起病,特征性不强,起始症状、体征不明显,缓慢进行性加重。入院前1个月内4次跌倒有可能是失张力性癫痫发作,入院1周后1 d内出现4次不同类型癫痫发作,并出现癫痫持续状态,癫痫发作为该患者主要特点。头颅磁共振成像病变范围广,脑室周较对称,白质为主,灰质亦受累,增强无强化,占位效应不明显。排除了颅内感染、多发性硬化等其他疾病。脑活检(取颞叶)病理为胶质母细胞瘤。肿瘤细胞免疫组化:GFAP(+++),Olig-2(+++),S-100(+),MGMT(++)。综合多种因素,确诊为脑胶质瘤病,替莫唑胺及贝伐单抗治疗6个月,缓慢进行性加重,肿瘤压迫致左侧侧脑室消失,已行手术减压,预后差。结论脑胶质瘤病起始表现隐袭,飞行人员体质强,发病后临床表现不易察觉。这就对临床航空医生提出更高的要求,对临床表现及检查、检验结果认真观察分析,尽早做出诊断,避免误诊。对飞行人员恶性肿瘤的飞行结论要根据病情轻重、飞行机种及飞行任务综合评定。Objective To investigate the pathogenesis,diagnosis and treatment of aircrew with GC,to inquire into the relations of malignancy with flying and the criteria of individual aero medical evaluation.Methods The clinical data of lcase of aircrew with gliomatosis cerebri was analyzed and related literatures were reviewed,Results The clinical manifestations were subacute onset.The initial symptoms and signs were not obvious,and the disease progresses more slowly.The patient fell down 4 times before pre hospital,which may be atonic seizures,and presented four different types of seizures,even found status epilepticusa in a day after admission.Seizures was the main characteristics of the patient.There was extensive head lesion in MRI,periventricular relatively symmetrical,and white matter was mainly involved,gray matter was also involved.There was no obvious enhancement.Intracranial infection,multiple sclerosis and other diseases were excluded.Brain biopsy was pathology of glioblastoma.Tumor cells by immunohistochemistry were GFAP（＋＋＋）,Olig-2（＋＋＋）,S-100（＋）,MGMT（＋＋）.In view of comprehensive variety of factors,the patient was diagnosed as glioma disease.Temozolomide and bevacizumab were used to treat for six months,caused slower progression.Cancer caused the left lateral ventricle disappeared.The patient treated by core decompression had a poor prognosis.Conclusion The clinical features of GC at early stage were obscure.The situation was more obvious in the aircrew because the health quality of aircrew is usually excellent before illness.Aviation physicians should raise the recognition level of the early features of GC so as to prevent wrong diagnosis,Aero medical assessment of flying personnel with malignancy should be evaluated according to clinical features,aircraft types and flight duties.

关 键 词：航空医学 脑胶质瘤病 飞行人员 合格鉴定 

分 类 号：R856.6[医药卫生—航空、航天与航海医学] R739.91[医药卫生—临床医学]