HIV 阴性的隐球菌性脑膜脑炎的 MRI 表现及临床意义  

MRI characteristics and evaluation of cryptococcus meningoencephalitis in HIV-negative patients

作　　者：易婷玉[1] 陈文伙[1] 吴宗忠[1] 吴燕敏[1] 陈跃鸿[1] 张梅芳[1] 

机构地区：[1]福建医科大学附属漳州市医院神经内科,福建漳州363000

出　　处：《实用放射学杂志》2016年第2期181-184,共4页Journal of Practical Radiology

摘　　要：目的：评价磁共振成像（MRI）在人类免疫缺陷病毒（HIV）阴性的隐球菌性脑膜脑炎（CM）的表现及预后判断。方法回顾性分析2000—2013年于本院由脑脊液墨汁染色及脑脊液细菌培养确诊的19例 HIV 阴性的 CM 的 MRI 表现及临床预后,采用格拉斯哥结局评分量表进行预后判断：1分=死亡,2分=永久植物状态,3分=严重残疾,4分=中度残疾,5分=恢复良好。1~3分归为预后差,4~5分为预后良好。结果84.2%（16/19）的 MRI 检查异常,84.2%（16/19）表现为脑膜强化,31.6%（6/19）为脑肿胀,47.4%（9/19）为脑实质病变,5.2%（1/19）为血管炎。平均随访时间3.5年,9例 MRI 证实脑实质病变中5例（5/9,44.4%）出现预后不良。结论 HIV 阴性的 CM 的 MRI 表现多样,当出现脑实质病变可能提示预后不良。Objective To search MRI features of patients with HIV-negative cryptococcus meningoencephalitis （CM）and evaluate the value in judging the prognosis of CM.Methods The findings of cranial MRI and prognosis were retrospectively analyzed in 19 cases with India-ink capsule staining-proved HIV-negative CM in our department.The prognosis was evaluated by Glasgow Outcome Scale：score 1=death,score 2=persistent vegetative state,score 3=severe disability,score 4=moderate disability,score 5=good recovery. The patients with score 1-3 were classified as the group of poor prognosis,while those with score 4,5 as good prognosis.Results Abnormal manifestations on cranial MRI were observed in 84.2%（1 6/1 9）cases,meninges enhanced in 84.2% （1 6/1 9）,brain edema in 31.6%（6/1 9）,brain parenchyma lesion in 47.4% （9/1 9 ）,vasculitis in 5.2% （1/1 9 ）.The mean duration of follow-up was 3.5 years,The prognosis of 5/9（44.4%）cases with brain parenchyma lesion confirmed by cranial MR was poor.Conclusion The MRI manifestation of HIV-negative CM is diverse,and brain parenchyma lesion confirmed by cranial MRI may associated with poor prognosis.

关 键 词：人类免疫缺陷病毒阴性 隐球菌性脑膜脑炎 磁共振成像 预后 

分 类 号：R512.3[医药卫生—内科学] R445.2[医药卫生—临床医学]