MRI及脑脊液分析在中枢神经系统感染鉴别中的应用价值

Application value of MRI and cerebrospinal fluid analysis in the identification of central nervous system infections

目的分析中枢神经系统感染鉴别中磁共振成像(MRI)及脑脊液分析的应用价值。方法选取75例中枢神经系统感染患者作为研究组,另选取75例脑脊液常规正常的头痛患者作为对照组。两组均行MRI及脑脊液分析。比较两组MRI征象、脑脊液参数及MRI联合脑脊液分析对不同中枢神经系统感染的鉴别诊断效能。结果研究组病毒性脑膜炎、化脓性脑膜炎、结核性脑膜炎患者的MRI异常检出率分别为45.00%、40.00%、67.50%,均高于对照组的1.33%,病毒性脑膜炎、化脓性脑膜炎患者的MRI异常检出率均低于结核性脑膜炎患者,差异有统计学意义(P<0.05)。研究组病毒性脑膜炎患者的糖、氯化物水平高于化脓性脑膜炎、结核性脑膜炎患者及对照组,化脓性脑膜炎、结核性脑膜炎患者的乳酸、乳酸脱氢酶、肌酸激酶、蛋白水平、白细胞计数、中性粒细胞均高于病毒性脑膜炎患者、对照组,差异有统计学意义(P<0.05);研究组结核性脑膜炎患者、对照组的脑脊液压力均高于病毒性脑膜炎、化脓性脑膜炎患者,差异有统计学意义(P<0.05);研究组结核性脑膜炎患者的中性粒细胞百分比高于病毒性脑膜炎、化脓性脑膜炎患者,差异有统计学意义(P<0.05);但研究组结核性脑膜炎患者的中性粒细胞百分比与对照组比较,差异无统计学意义(P>0.05)。MRI联合脑脊液分析诊断病毒性脑膜炎、结核性脑膜炎的敏感度分别为70.00%、62.50%,均高于化脓性脑膜炎的26.67%,差异有统计学意义(P<0.05);MRI联合脑脊液分析诊断病毒性脑膜炎、化脓性脑膜炎、结核性脑膜炎的特异度、准确度比较,差异无统计学意义(P>0.05)。结论中枢神经系统感染鉴别中MRI及脑脊液分析联合诊断的应用价值高。

Objective To analyze the application of magnetic resonance imaging(MRI)and cerebrospinal fluid analysis in the identification of central nervous system infections.Methods 75 patients with central nervous system infection were selected as the research group,and another 75 headache patients with normal cerebrospinal fluid were selected as the control group.MRI and cerebrospinal fluid analysis were performed in both groups.MRI signs,cerebrospinal fluid parameters of the two groups were compared,as well as the efficacy of MRI combined with cerebrospinal fluid analysis for the differential diagnosis of different central nervous system infections.Results In the research group,the detection rates of MRI abnormalities in patients with viral meningitis,purulent meningitis and tuberculous meningitis were 45.00%,40.00%and 67.50%,all of which were higher than that of 1.33%in the control group;the detection rates of MRI abnormalities in patients with viral meningitis and purulent meningitis were lower than those in patients with tuberculous meningitis;the differences were statistically significant(P<0.05).In the research group,the levels of glucose and chloride in patients with viral meningitis were higher than those in patients with purulent meningitis,tuberculous meningitis and the control group;the levels of lactate,lactate dehydrogenase,creatine kinase,protein,white blood cell count and neutrophils in patients with purulent meningitis and tuberculous meningitis were higher than those in patients with viral meningitis and control group;the differences were statistically significant(P<0.05).The cerebrospinal fluid pressure in patients with tuberculous meningitis and the control group was higher than that in patients with viral meningitis and purulent meningitis,and the difference was statistically significant(P<0.05).In the research group,the percentage of neutrophils in patients with tuberculous meningitis was higher than that in patients with viral meningitis and purulent meningitis,and the difference was statistically significant(P<0.05).However,there was no significant difference in the percentage of neutrophil in the patients with tuberculous meningitis compared with the control group(P>0.05).The sensitivity of MRI combined with cerebrospinal fluid analysis for the diagnosis of viral meningitis and tuberculous meningitis were 70.00%and 62.50%,which were higher than that of 26.67%for purulent meningitis,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the specificity and accuracy of MRI combined with cerebrospinal fluid analysis in the diagnosis of viral meningitis,purulent meningitis and tuberculous meningitis(P>0.05).Conclusion MRI combined with cerebrospinal fluid analysis is of high value in the identification of central nervous system infection.