超声测量视神经鞘直径和脑血流参数在艾滋病隐球菌脑膜炎颅内高压中的应用价值  

Application value of ultrasonic measurement of optic nerve sheath diameter and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococcal meningitis

作　　者：杜珊 王翔 阳建政 黎霞 胡小丽[1] DU Shan;WANG Xiang;YANG Jianzheng;LI Xia;HU Xiaoli(Guizhou Medical University,Guiyang,Guizhou 550004,China;Department of Ultrasound,Chongqing Public Health Medical Center,Chongqing 400036,China;Department of Ultrasound,The Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China)

机构地区：[1]贵州医科大学,贵阳550004 [2]重庆市公共卫生医疗救治中心超声科,重庆400036 [3]重庆医科大学附属第三医院超声科,重庆401120

出　　处：《重庆医学》2024年第4期592-596,602,共6页Chongqing medicine

基　　金：重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX1048)。

摘　　要：目的探讨超声测量视神经鞘直径(ONSD)和脑血流参数在艾滋病隐球菌脑膜炎颅内高压中的应用价值。方法选取2022年2-7月重庆市公共卫生医疗救治中心确诊的27例艾滋病隐球菌脑膜炎患者,所有患者均行超声测量ONSD及经颅超声测量颅内大脑中动脉(MCA)脑血流参数,包括收缩期峰值流速(PSV)、舒张期末流速(EDV)、收缩期峰值流速/舒张期末流速(S/D)、阻力指数(RI),而后行腰椎穿刺术并记录颅内压(ICP),将ICP≥200 mmH_(2)O定义为ICP增高组,ICP<200 mmH_(2)O定义为ICP正常组,另选择17例不伴并发症的艾滋病患者作为对照组。比较3组患者基线资料、ONSD及MCA脑血流参数,将差异有统计学意义的指标与ICP进行相关分析,绘制受试者工作特征(ROC)曲线分析ONSD值对艾滋病隐球菌脑膜炎颅内高压的诊断效能。结果ICP增高组、ICP正常组及对照组3组患者性别、年龄、收缩压、舒张压差异均无统计学意义(P>0.05)。3组患者MCA的PSV、EDV、S/D、RI组间差异也无统计学意义(P>0.05),3组患者ONSD差异有统计学意义(P<0.05)。艾滋病隐球菌脑膜炎患者ICP与ONSD呈正相关(P<0.01,r=0.736)。ROC曲线分析显示,ONSD截断值为3.965 mm时,其对艾滋病隐球菌脑膜炎患者颅内高压的诊断效能最高,ROC曲线下面积为0.90(95%CI:0.714~1.000,P=0.001),灵敏度为90%,特异度为100%。结论超声测量ONSD能有效预测艾滋病隐球菌脑膜炎患者ICP,指导临床及时采取减压措施,值得临床推广应用。Objective To explore the application value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococcal meningitis.Methods A total of 27 patients with cryptococcal meningitis diagnosed by Chongqing Public Health Medical Center from February to July,2022 were included.All patients were examined with ultrasound measurement of ONSD and ultrasound measurement of cerebral blood flow of intracranial middle cerebral artery(MCA),including peak systolic velocity(PSV),end diastolic velocity(EDV),peak systolic velocity/end diastolic velocity(S/D)and resistance index(RI),and then lumbar puncture was performed and intracranial pressure(ICP)was recorded.The ICP≥200 mmH_(2)O was defined as the ICP increased group,ICP<200 mmH_(2)O was defined as the ICP normal group,and 17 AIDS patients without complications were selected as the control group.The baseline data,ONSD and MCA cerebral blood flow parameters of the three groups were compared,and the statistically significant indexes were correlated with ICP,and the receiver operating characteristic(ROC)curve of the subjects was drawn to analyze the diagnostic efficacy of ONSD value in predicting intracranial hypertension caused by AIDS cryptococcal meningitis.Results There were no significant differences in gender,age,systolic blood pressure or diastolic blood pressure among the ICP increased group,the ICP normal group and the control group(P>0.05).There were no significant differences in PSV,EDV,S/D and RI among the three groups of MCA(P>0.05),but there was significant difference in ONSD among the three groups(P<0.05).There was a positive correlation between ICP and ONSD in the patients with AIDS cryptococcal meningitis(P<0.01,r=0.736).The ROC curve analysis showed that when the ONSD cutoff value was 3.965 mm,it predicted the highest efficacy of intracranial high pressure in the patients with AIDS cryptococcal meningitis.The area under the ROC curve was 0.90(95%CI:0.714-1.000,P=0.001),the

关 键 词：艾滋病 隐球菌性脑膜炎 视神经鞘直径 脑血流参数 颅内高压 应用 

分 类 号：R445.1[医药卫生—影像医学与核医学]