脑脊液多细胞化患者的特征和诊断谱
Susanne Dyckhoff-Shen1, Jan P Bewersdorf2, Nina C Teske3
1Department of Neurology, LMU University Hospital, LMU Munich (en.), Marchioninistr. 15, 81377, Munich, Germany. Susanne.dyckhoff@med.uni-muenchen.de.
CHANCE评分有效地区分了细菌性脑膜炎与脑脊液 (CSF) 细胞病的其他原因. 这种工具有助于临床医生识别患有细菌性脑膜炎高概率的患者,提高诊断准确度.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 临床诊断 临床诊断 临床诊断
背景情况:
- 大脑脊髓液 (CSF) 细胞瘤可以源于各种疾病,包括感染,自身免疫疾病和瘤疾病.
- 仅基于CSF特征的细菌性脑膜炎 (BM) 与其他导致CSF多细胞形成的原因的区别是具有挑战性的,因为这些特征重叠.
研究的目的:
- 在一大群患者中描述CSF细胞瘤的病因.
- 开发和验证一种工具,以区分细菌性脑膜炎与CSF多细胞症的其他原因.
主要方法:
- 进行了一项追溯队列研究,对1150名脑脊液白细胞数量升高 (>5细胞/μl) 的患者进行了研究.
- 分析了临床表现,实验室参数,诊断和结果.
- 使用多变量回归模型来确定区分BM的关键指标,从而开发了CHANCE评分.
主要成果:
- 传染性中枢神经系统疾病 (34%),自身免疫性疾病 (21%) 和瘤性疾病 (16%) 是中枢神经液多细胞症的最常见原因.
- 与其他病因相比,中枢神经系统感染中检测到的病原体的CSF细胞数量显著更高.
- CHANCE评分,包括CSF细胞计数,蛋白质,CRP,白细胞计数,精神状态和部刚性,实现了高灵敏度 (92.1%) 和特异性 (90.9%) 识别BM.
结论:
- 传染病,瘤和自身免疫性中枢神经系统疾病约占CSF多细胞瘤病例的70%.
- CHANCE评分是识别患有细菌性脑膜炎高概率的患者的宝贵工具,有助于临床决策.
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