DESH评分预测特发性正常压力脑积水脑脊液放液试验的效果

The prediction effects of disproportionately enlarged subarachnoid space hydrocephalus scoring for cerebrospinal fluid tap test in patients with suspected idiopathic normal pressure hydrocephalus

目的探讨蛛网膜下腔不成比例扩大的脑积水(DESH)评分在疑似特发性正常压力脑积水(iNPH)患者腰穿脑脊液放液试验效果中的预测价值。方法回顾性分析2016年1月—2017年4月,46例疑似i NPH且行脑脊液放液试验的患者资料。评估患者放液试验前、后的3 m计时起立行走试验、简易精神状态检查及特发性正常压力脑积水分级评分。根据DESH评分标准,对患者放液试验前的脑室扩大、侧裂池扩大、大脑高凸面及中线的蛛网膜下腔狭窄、胼胝体角和局部脑沟扩大程度进行评分。分析DESH评分、Evans’指数和胼胝体角与脑脊液放液试验效果之间的关系。结果脑脊液放液试验阳性者DESH评分高于阴性者[(5.33±1.81)分vs(3.32±1.22)分,P=0.001],阳性者与阴性者Evans’指数、胼胝体角差异无统计学意义。结论DESH评分可能有助于预测脑脊液放液试验的效果,评分越高脑脊液放液试验阳性可能性越大。

Objective To explore the prediction effects of disproportionately enlarged subarachnoid space hydrocephalus(DESH)scoring for cerebrospinal fluid tap test(CSFTT)in patients with suspected idiopathic normal pressure hydrocephalus(iNPH).Methods Forty-six patients with suspected iNPH from January 2016 to April 2017 were included and their clinical data were retrospectively analyzed.All patients were evaluated before and after CSFTT using 3-meter timed up and go test(TUG),mini-mental state examination(MMSE)and idiopathic normal pressure hydrocephalus grading scale(iNPHGS).According to the DESH scoring criteria,the ventriculomegaly,dilated sylvian fissures,tight high convexity,acute callosal angle,and focal sulcal dilation of these patients were evaluated before CSFTT,and the relationship between DESH score and CSFTT result was analyzed.The Evans'index and callosal angle were measured and the relationships between the Evans'index and callosal angle and CSFTT result were also analyzed.Results The DESH score of the CSFTT responders was significantly higher than that of the CSFTT non-responders(5.33±1.81)vs(3.32±1.22).There were no significant differences in Evans'index and callosal angle between CSFTT responders and non-responders.Conclusion DESH scoring is helpful to predict the effects of CSFTT in patients with suspected iNPH.The higher the DESH score,the higher the possibility of positive CSFTT.