结核性脑膜炎患者出现MRA异常的相关因素分析及其对预后的影响  

MR angiography abnormality in patients with tuberculous meningitis： correlation factor and prognostic significance analyses

作　　者：卢婷婷[1] 陆正齐[1] 杨清燕[2] 刘旭[1] 戴永强[1] 

机构地区：[1]中山大学附属第三医院神经内科,广州510630 [2]香港大学深圳医院神经内科,深圳518053

出　　处：《中华神经医学杂志》2016年第10期1047-1051,共5页Chinese Journal of Neuromedicine

基　　金：（1）基金项目：广东省科技计划项目（20128031800041）（2）基金项目：广东省医学科学技术研究基金（A2016224）

摘　　要：目的分析结核性脑膜炎（TBM）患者出现磁共振血管成像（MRA）异常的相关因素及其对TBM预后的影响。方法选取自2007年1月至2014年11月中山大学附属第三医院神经内科收治的103例TBM患者为研究对象，收集患者临床资料、实验室检查结果、MRA影像以及治疗后6个月的随访预后情况，使用Logistic回归模型分析出现MRA异常的相关因素并探讨其对TBM预后的影响。结果本组患者中出现MRA异常者共45例（43．7％）。Logistic回归分析显示年龄≥50岁（OR=7．034，95％CI：1．797～27．536，P=-0．005）、局灶性肢体无力（OR=10．728，95％CI：2．042～56．359，P=0．005）、脑积水（OR：15．007，95％CI：2．572-87．577，19=-0．003）、颅底粘连（OR=4．001，95％CI：1．139～14．056，P=-0．0311是出现MRA异常的相关因素。MRI显示有梗死病灶的37例患者中有29例存在人院时MRA异常，出现抗结核药反常反应的27例患者中有17例存在入院时MRA异常，预后不良的9例患者中有7例存在入院时MRA异常。结论TBM患者MRA异常常见且与脑梗死、抗结核药反常反应、预后不良有一定关联。高龄、临床出现局灶性肢体无力症状及MRI影像上出现脑积水、颅底粘连的TBM患者易出现MRA异常。Objective To evaluate the related factors of magnetic resonance angiography （MRA） abnormality and its prognostic value in patients with tuberculous meningitis （TBM）. Methods One hundred and three TBM patients, admitted to our hospital from January 2007 to November 2014, were chosen in our study; their clinical data, laboratory examinations, MRA data and prognoses 6 months after onset were collected; Logistic regression analysis was performed to analyze the related factors of MRA abnormality, and the influence of these factors in prognosis of TBM was investigated. Results MRA was abnormal in 45 patients （43.7%）. Logistic regression analysis indicated that age （older than 50 years）, focal weakness, hydrocephalus and basal exudates were the related factors of MRA abnormality （OR=7.034, 95%CI： 1.797-27.536, P=0.005; OR=10.728, 95%（21： 2.042-56.359, P=0.005; OR=15.007, 95%CI： 2.572-87.577, P=0.003; OR--4.001, 95%CI： 1.139-14.056, P=-0.031）. In 37 patients with infarction in MR imaging, 29 had MRA abnormality at admission; in 27 patients having paradoxical reaction of antitubercular agents, 17 had MRA abnormality at admission; in 9 patients with poor prognosis, 7 had MRA abnormality at admission. Conclusion MRA abnormality is common in TBM patients and it is associated with inTuberculous Meningitis; Infarction; Vasculitis; Magnetic resonance angiographyfarction, paradoxical reaction of antitubercular agents and poor outcomes; patients having elder age, focal weakness as well as hydrocephalus and basal exudates on MR imaging are trended to have MRA abnormality.

关 键 词：结核性脑膜炎 脑梗死 血管炎 磁共振血管成像 

分 类 号：R529.3[医药卫生—内科学]