脑囊虫病临床表现和脑脊液生化指标及MRI影像学特征

Clinical manifestations,biochemical indexes in cerebrospinal fluid and MRI characteristics of patients with cerebral cysticercosis

目的 分析某地区脑囊虫病患者临床表现、脑脊液生化指标及磁共振成像(MRI)影像学特点。方法 选择2017年2月-2020年10月海南省中医院确诊的82例脑囊虫病患者为研究对象,以同期医院收治的82例原发性癫痫患者为对照组。分析脑囊虫病患者临床表现和MRI影像学特点。检测两组患者脑脊液生化指标[亮氨酸氨基肽酶(LAP)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、谷酰转肽酶(GGT)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、总蛋白(TP)、肌酸激酶同工酶B(CK-B)、Ca^(2+)、K^(+)、Cl^(-)、Na^(+)离子],检测血清干扰素γ(IFN-γ)、白细胞介素(IL)-2、IL-4、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)和可溶性细胞间黏附分子-1(sICAM-1)水平。结果 脑囊虫病患者病理类型主要为脑实质型(85.37%),临床主要表现为癫痫发作(56.10%)、头痛头晕(46.34%)和局灶性神经损害体征(17.07%),在农民、农村和养猪人群中较为多见。脑脊液AST、ALT、GGT、TP、ALP、LDH、Ca^(2+)水平均高于对照组(P<0.05),血清IFN-γ和IL-2水平均低于对照组(P<0.05),IL-4、IL-6、IL-10、TNF-α和sICAM-1水平均高于对照组(P<0.05)。MRI检测可见脑实质型T1WI显示囊腔呈略高于脑脊液的低信号,头节与脑实质等信号,略高于囊液,T2WI显示囊腔呈略低于脑脊液的高信号,头节信号略低于囊液;原发性癫痫患者在T1WI和T2WI上病灶组织呈现等信号。结论 脑囊虫病感染与职业、居住环境和是否养猪有关,临床可根据脑脊液生化指标、血清细胞因子和MRI特点进行疾病诊断和病变评估。

OBJECTIVE To investigate the clinical manifestations,biochemical indexes in cerebrospinal fluid and magnetic resonance imaging(MRI)characteristics of patients with cerebral cysticercosis.METHODS A total of 82 patients who were diagnosed with cerebral cysticercosis in Hainan Hospital of Traditional Chinese Medicine from Feb 2017 to Oct 2020 were recruited as the study objects,and 82 patients with primary epilepsy who were treated in the hospital were chosen as the control group.The clinical manifestations and MRI imaging characteristics of the patients with cerebral cysticercosis were analyzed.The levels of cerebrospinal fluid indexes[leucine aminopeptidase(LAP),aspartate aminotransferase(AST),alanine aminotransferase(ALT),glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),lactic acid dehydrogenase(LDH),total protein(TP),creatine kinase isoenzyme B(CK-B),Ca^(2+),K^(+),Cl^(-),Na^(+) ions]were detected,and the levels of serum interferonγ(IFN-γ),interleukin(IL)-2,IL-4,IL-6,IL-10,tumor necrosis factor-α(TNF-α)and soluble intercellular adhesion molecule-1(sICAM-1)were detected.RESULTS According to the pathological types,the cerebral cysticercosis with parenchymal type accounted for 85.37%.According to the clinical manifestations,the patients with epilepsy seizure accounted for 56.10%,the patients with headache and dizziness 46.34%,the patients with signs of focal neurological damage 17.07%;those manifestations were more common among farmers and population in rural areas and pig raising crowd.The levels of cerebrospinal fluid AST,ALT,GGT,TP,ALP,LDH and Ca^(2+) of the study group were significantly higher than those of the control group(P<0.05),the levels of serum IFN-γand IL-2 of the study group were significantly lower than those of the control group(P<0.05),and the levels of IL-4,IL-6,IL-10,TNF-αand sICAM-1 of the study group were significantly higher than those of the control group(P<0.05).MRI showed that there were low signals slightly higher than CSF in cyst cavity of parenchymal type on T1 WI,and equal signals of cephalomere and brain parenchyma,slightly higher than cyst fluid.There were high signals slightly lower than CSF in cyst cavity on T2 WI,and equal signals of cephalomere and brain tissues,slightly lower than cyst fluid.In patients with primary epilepsy,the focal tissues showed equal signals on T1 WI and T2 WI.CONCLUSION The cerebral cysticercosis is associated with the occupation,living environment and feeding pigs.It is necessary for the hospital to diagnose and assess the lesions based on the cerebrospinal fluid biochemical indexes,serum cytokines and MRI features.