结核性脑膜炎患者脑脊液多形核中性粒细胞水平以及颅脑磁共振影像表现与预后的关系  

Relationship between cerebrospinal fluid polymorphonuclear neutrophils and brain MRI manifestations and prognosis in patients with tuberculous meningitis

作　　者：付文君 张亚苹 李会会 刘建茂 王婷 FU Wenjun;ZHANG Yaping;LI Huihui;LIU Jianmao;WANG Ting(Department of Neurology,Heze Municipal Hospital,274000,China)

机构地区：[1]菏泽市立医院神经内科,274000

出　　处：《传染病信息》2024年第6期514-519,共6页Infectious Disease Information

基　　金：山东省基础研究计划项目(202203021222393)。

摘　　要：目的探讨结核性脑膜炎(tuberculous meningitis,TBM)患者脑脊液(cerebrospinal fluid,CSF)多形核中性粒细胞(polymorphonuclear neutrophils,PMN)水平以及脑磁共振影像(magnetic resonance imaging,MRI)表现与预后的关系。方法回顾性分析2022年4月至2023年10月期间在菏泽市立医院神经内科住院治疗的48例TBM患者临床资料,分析患者基线CSF PMN水平以及颅脑MRI表现与预后的关系。主要研究终点是治疗6个月时功能恢复和存活状态,次要终点是强化治疗2个月时MRI表现是否恶化。结果16例患者在治疗6个月时恢复不良(格拉斯哥预后评分≤3分),包含11例死亡和5例严重残疾。存活患者中,29例患者2个月时发生MRI表现恶化。相较6月时恢复良好的患者,恢复不良患者的CSF PMN水平和MRI异常表现个数显著升高(P<0.05),尤其是MRI表现为脑梗死和颅神经强化患者比例升高(P<0.05)。二元Logistic回归分析显示,MRI异常表现>3个及CSF PMN≥47.50%都是TBM患者恢复不良的独立影响因素(P均<0.05)。受试者工作特征曲线分析结果显示,MRI异常表现、CSF PMN以及2者联合预测6个月时患者恢复情况的曲线下面积分别为0.824(95%CI:0.703~0.945)、0.819(95%CI:0.695~0.943)、0.887(95%CI:0.795~0.978)。与存活患者比较,在死亡患者中MRI异常表现个数及CSF PMN水平均显著升高(P均<0.05)。而且在存活患者中,MRI表现恶化患者的MRI异常表现个数及CSF PMN水平均显著更高(P均<0.05)。结论CSF PMN联合基线MRI表现对TBM患者的预后具有较高的预测价值,当基线MRI表现的脑异常情况越复杂、CSF PMN水平越高,预示患者的预后越差。Objective To investigate the relationship between cerebrospinal fluid polymorphonuclear neutrophils(CSF PMN)levels and brain magnetic resonance imaging(MRI)performance and prognosis in patients with tuberculous meningitis(TBM).Methods Retrospective analysis of data from 48 TBM patients admitted to the neurology department of Heze Municipal Hospital from April 2022 to October 2023.All patients underwent baseline cranial MRI examination and CSF analysis.The primary endpoint of this study was functional recovery and survival status at 6 months,while the secondary endpoint was whether MRI findings worsened after 2 months of intensive treatment.Analyze the relationship between CSF PMN levels,MRI findings,and prognosis.Results Sixteen patients had poor recovery(Glasgow prognosis score≤3)at 6 months,comprising 11 deaths and 5 severely disabled patients.Of the surviving patients,29 patients experienced deterioration in MRI at 2 months.Compared with the patients with good recovery at 6 months,the CSF PMN level and the number of abnormal MRI findings in the patients with poor recovery were significantly increased(P<0.05),especially the proportion of patients with cerebral infarction and cranial nerve enhancement on MRI was increased(P<0.05).Binary logistic multifactorial showed that both MRI abnormal manifestations>3 and CSF PMN≥47.50%were independent influences on poor recovery in patients with TBM(P<0.05).The receiver operating characteristic results showed that the area under the curve for MRI abnormal manifestations,CSF PMN,and the combination of the two in predicting the recovery of the patients at 6 months was 0.824(95%CI:0.703-0.945),0.819(95%CI:0.695-0.943),0.887(95%CI:0.795-0.978),all P<0.001.Compared with surviving patients,the number of abnormal MRI findings and CSF PMN levels were significantly increased in deceased patients(P<0.05).Moreover,the patients with severe survival and worsening MRI almost had more abnormal MRI findings and CSF PMN levels(P<0.05).Conclusion CSF PMN combined with baseline MRI perfo

关 键 词：结核性脑膜炎 多形核中性粒细胞 磁共振影像 格拉斯哥预后评分 

分 类 号：R529.3[医药卫生—内科学]