头颅MR增强扫描在急性血行播散性肺结核患者中筛查结核性脑膜炎的价值

The Screening Value of Cranial MR Enhancement Scan for Tuberculous Meningitis in Patients with Acute Hematogenous Disseminated Pulmonary Tuberculosis

目的探讨头颅MR增强扫描在急性血行播散性肺结核患者中筛査结核性脑膜炎的价值。方法捜集北京胸科医院2012年1月至2018年5月住院的415例急性血行播散性肺结核患者的临床资料,筛选出进行了头颅MR增强扫描及脑脊液常规及生化检査的患者235例,男:女=1.12:1(124/111),年龄15-87岁,平均年龄(36±18)岁,15~35岁年龄组患者占62.1%(146/235).采用SPSS22.0软件进行统计分析,计数资料组间比较采用卡方检验。当总数>40,且1<理论频数<5时采用校正卡方检验。配对计数资料的比较采用配对卡方检验,以P<0.05为差异有统计学意义。结果235例急性血行播散性肺结核患者,头颅MR增强扫描发现的异常率(89.8%,211/235)较脑脊液常规及生化(63.0%,148/235)高,差异有统计学意义(McNemar检验,4=0.000)。按照结核性脑膜炎诊断标准,"确诊"及"很可能"结核性脑膜炎219例中,头颅MR增强扫描发现的异常率(96.3%,211/219)较脑脊液常规及生化检査(67.6%,148/219)高,且差异有统计学意义(McNemar检验,P=0.000)。有中枢神经系统症状的143例患者中,头颅MR增强扫描发现的异常率(95.8%,137/143)较脑脊液常规及生化发现的异常率(88.1%,126/143)高,差异有统计学意义(McNemar检验,P=0.035)。无中枢神经系统症状的76例患者中,头颅MR增强扫描发现的异常率(97.4%,74/76)较脑脊液常规及生化高(28.9%,22/76),差异有统计学意义(McNemar检验,P=0.000).有中枢神经系统症状与无中枢神经系统症状患者的头颅MR增强扫描发现的异常率[95.8%(137/143)与97.4%(74/76)]比较,差异无统计学意义(校正χ^2,检验,P=0.834);有中枢神经系统症状较无中枢神经系统症状患者脑脊液常规及生化检査发现的异常率[88.1%(126/143)与28.9%(22/76 )]高,差异有统计学意义(χ^=79.286, P=0.000 ).结论头颅MR增强扫描在急性血行播散性肺结核患者中对颅内病变的发现率高;特别是对于无神经系统症状的结核性脑膜炎患者,脑脊液常规及生化检查发现的异常率偏低,而头颅MR增强扫描发现的异常率仍>95%.

Objective To explore the screening value of cranial MR enhancement scan for tuberculous meningitis in patients with acute hematogenous disseminated pulmonary tuberculosis.Methods The clinical data of 415 patients with acute hematogenous disseminated pulmonary tuberculosis admitted to Beijing Chest Hospital from January 2012 to May 2018 were collected.Two hundred and thirty-five patients with cranial MR enhancement scan and cerebrospinal fluid routine and biochemistry were selected,the ratio of male to female was 1.12 : 1 (124/111),age ranged from 15 to 87 years,mean age was (36 ± 18) years,and patients aged 15-35 years accounted for 62.1%(146/235).We used Chi-square test to compare the count data.The corrected Chi-square test was used when the total number was >40 and 1< theoretical frequency <5.Paired count data was compared using paired Chi-square test by SPSS 22.0 software,and the difference was statistically significant at P<0.05.Results Of 235 patients with acute hematogenous disseminated pulmonary tuberculosis,the abnormal rate of cranial (89.8%,211/235) was higher than that of cerebrospinal fluid (63.0%,148/235),the difference was statistically significant (McNemar test,P=0.000).The abnormal rate of cranial MR enhancement scan (96.3%,211/219) was higher than that of cerebrospinal fluid (67.6%,148/219) in 219 cases with tuberculous meningitis,and the difference was statistically significant (McNemar test,P=0.000).Of 143 patients with central nervous system symptoms,the abnormal rate of cranial MR enhancement scan (95.8%,137/143) was significantly different from that of cerebrospinal fluid (88.1%,126/143)(McNemar test,P=0.035).Of 76 patients without central nervous system symptoms,the abnormal rate of cranial MR enhancement scan (97.4%,74/76) was higher than that of cerebrospinal fluid (28.9%,22/76),the difTerence was statistically significant (McNemar test,P=0.000).There was no significant difference in abnormal rate of cranial MR enhancement scan between patients with and without central nervous system symptoms (95.8%(137/143) vs 97.4%(74/76))(adjusted χ^2 test,P=0.834).The abnormal rate of cerebrospinal fluid (88.1%(126/143) vs 28.9%(22/76)) was higher in patients with central nervous system symptoms than that without central nervous system symptoms,and the difference was statistically significant (χ^2=79.286,P=0.000).Conclusion Granial MR enhancement scan has a high rate of detection of intracranial lesions in patients with acute hematogenous disseminated pulmonary tuberculosis.Especially for patients with tuberculous meningitis without neurological symptoms,the abnormal rate of cerebrospinal routine and biochemical fluid is low,and the abnormal rate of cranial MR enhancement scan is still higher than 95%.