散发性Creutzfeldt-Jakob病病程不同时期的辅助检查敏感性研究  

The sensitivity of auxiliary examinations in different stages of sporadic Creutzfeldt-Jakob disease

作　　者：蒋胶胶 张家堂[1] 陈妤[1] 郑娜[1] 邵龙[1] 王威[1] 黄旭升[1] 于生元[1] 

机构地区：[1]解放军总医院神经内科,北京100853

出　　处：《解放军医学杂志》2017年第5期445-451,共7页Medical Journal of Chinese People's Liberation Army

基　　金：解放军总医院"百项优势"项目"中国人亚急性海绵状脑病早期诊疗规范";解放军总医院2016临床科研扶持基金项目(2016FC-CXYY-1002)~~

摘　　要：目的研究散发性Creutzfeldt-Jakob病(sCJD)患者在病程的不同时期时各项辅助检查手段的敏感性。方法回顾性分析53例sCJD患者的临床资料,统计病程不同时期头颅核磁弥散加权像(DWI)、24h动态脑电图(EEG)、脑脊液14-3-3蛋白及正电子发射计算机断层显像(PET-CT)的敏感性。在计算某一检测手段的敏感性时,以特异性临床表现结合2项或以上辅助检查阳性结果作为诊断的公认标准。结果在53例sCJD患者中,列入病程早期、中期及晚期统计的例数分别为24、53、22例(其中部分患者跨越2或3个时期)。随病程进展,DWI敏感性(早期:58.3%;中期:84.6%;晚期:94.7%)、EEG敏感性(早期:45.8%;中期:62.7%;晚期:77.8%)、脑脊液14-3-3蛋白的敏感性(早期:11.1%;中期:52.9%)及PET-CT的敏感性(早期:80%;中期:100%)均逐渐增高。除晚期未行PET-CT检查外,其他各期PET-CT的敏感性均优于其他辅助检查。结论 sCJD患者在病程不同时期各辅助检查的敏感性不同,在病程不同阶段进行多次复查可提高诊断的敏感性。PET-CT检查的敏感性较高,结合其他检查手段诊断sCJD可起到较为关键的作用。Objective To analyze the sensitivity of auxiliary examinations in different periods of sporadic Creutzfeldt-Jakob disease （sCJD）. Methods The clinical data of 53 sCJD patients were retrospectively analyzed including the different stages of skull diffusion-weighted magnetic resonance imaging （DWI）, 24-hour ambulatory electroencephalogram （EEG）, 18F-FDG PET/CT （PET-CT） and cerebrospinal fluid 14-3-3 protein. When calculating the sensitivity of an auxiliary examination, the diagnostic criteria were defined by combining the specific clinical manifestations with two or more positive results of other auxiliary examinations. Results There were 24, 53 and 22 sCJD patients, respectively, met the criterion of early （E）, middle （M） and later （L） stage of disease （some patients fit 2 or 3 stages）. The sensitivity of DWI （E： 58.3%, M： 85.4%, L： 94.7%）, EEG （E： 45.8%, M： 62.7%, L： 77.8%）, 14-3-3 protein in cerebrospinal fluid （E： 11.1%, M： 52.9%） and PET-CT （E： 80%, M： 100%） increased gradually with disease progression. The sensitivity of PET-CT was higher than the other auxiliary examinations for E and M stages; no PET-CT was conducted in L stage. High signal regions mainly distributed in the cortex in E and M stages, but in L stage, no significant difference was found on the distribution of high signal regions between cortex and basal ganglia. Conclusions The sensitivities of the auxiliary examinations were different for sCJD patients in different stages. Reexaminations in different periods may improve the sensitivity for sCJD diagnosis. The sensitivity of PET-CT was high, and the combination of PET-CT and other auxiliary examinations may play a key role in the diagnosis of sCJD.

关 键 词：CREUTZFELDT-JAKOB病 弥散加权成像 脑电图 14-3-3蛋白质类 正电子发射断层显像术 

分 类 号：R742.9[医药卫生—神经病学与精神病学]