目的 探讨增强T2FAIR系列在结核性脑膜炎(TBM)中的诊断价值。方法 选择临床疑似TBM并初次行MR检查的患者80例,根据TBM诊断评分标准和颅内结核影像学分型专家共识作为临床确诊依据。最终56例经临床确诊为TBM(脑脊液结核杆菌抗酸检测阳性)。行常规系列颅脑扫描后增加增强T2FIR系列扫描。由三位经验丰富从事影像专业诊断不同级别的医师分别进行独立分析诊断,以明显强化、轻度强化和无明显强化对比分析增强三维快速扰相梯度回波T1WI(T1GRE3D-FS)序列和增强T2FIR系列对TBM脑膜病变和脑实质的显示程度。结果 增强T2FLAIR系列52例显示脑膜明显强化占92.5%;4例不明显强化占7.5%。T1GRE3D-FS序列 8例明显强化占14%,39例轻度强化占70%;9例无明显强化占16%。增强T2FLAIR系列43例显示脑实质明显强化占76.8%;13例轻度强化占23.2%。T1GRE3D-FS序列48例明显强化占86%;8例轻度强化占14%。两系列对脑实质的显示均有轻度强化。结论 增强T2FAIR系列可作为TBM早期常规系列用于TBM的MR增强检查,能显著提高TBM影像诊断的准确性,,弥补了常规MR增强TlWI对结核性脑膜炎诊断的不足。

Objective To investigate the diagnostic value of enhanced T2FAIR series in tuberculous meningitis (TBM) patients. Methods 80 patients with suspected clinical TBM and initial MR examination were selected as the basis for clinical diagnosis according to the TBM diagnostic scoring standard and the expert consensus of intracranial tuberculosis imaging classification. Finally,56 cases were clinically confirmed as positive for acid resistance in TBM. Enhanced T2FIR series scans were added after routine series craniocerebral scanning. Independent diagnostic analysis was performed by three experienced imaging specialists. By different levels of diagnosis with significant enhancement, mild enhancement and no mild enhancement, we made contrast analysis in display of enhanced three-dimensional fast scrambling phase gradient echo T1WI (T1GRE3D-FS) sequence and enhanced T2FIR series on TBM meningeal lesions and brain parenchyma. Results 52 cases of enhanced T2FLAIR series showed significant enhancement of the meninges in 92.5%; in 4 cases,7.5% were not significantly enhanced. 8 cases of T1GRE3D-FS sequences were significantly enhanced, accounting for 14%, 39 cases of mild enhancement accounted for 70%; no significant enhancement was found in 9 cases, accounting for 16%. Enhanced T2FLAIR series of 43 cases showed significant enhancement of brain parenchyma accounted for 76.8%; 13 cases of mild enhancement accounted for 23.2%. 48 cases of T1GRE3D-FS sequences were significantly enhanced accounted for 86%; 8 cases of mild enhancement accounted for 14%. Both series showed mild enhancement of brain parenchyma. Conclusion The enhanced T2FAIR series can be used as TBM early routine series for MR enhanced examination, it may significantly improve the accuracy of TBM imaging diagnosis, to make up the deficiency of conventional MR.

目的 分析小婴儿化脓性脑膜炎的临床特点,探讨其预测因子。方法 回顾性分析我科2015—2017年53例小月龄化脓性脑膜炎患儿的临床资料。以同时期、同年龄层的细菌感染患儿81例为观察组。通过单因素和多因素分析进行两组比较。结果 单因素分析提示早产儿、激惹、嗜睡、前囟紧张、颈强直及循环不良方面有差异。脑脊液白细胞数量、蛋白浓度、糖浓度,糖与同期血糖比值以及乳酸脱氢酶浓度均有明显差异。多因素分析提示仅脑脊液蛋白及乳酸脱氢酶有统计学意义。受试者工作曲线显示脑脊液蛋白、乳酸脱氢酶及两项指标合并的诊断效能均较高。结论 小婴儿化脓性脑膜炎患儿缺乏典型表现,密切关注早产儿基础疾病,激惹、嗜睡、前囟紧、颈强直及循环不良的临床表现,脑脊液蛋白及乳酸脱氢酶等实验室指标,有利于早期识别,及时干预,减少不良事件的发生。

Objective We aimed to analyze the clinical characteristics of community acquired purulent meningitis(PM) in infants and explore the predictors of early diagnosis. Methods Retrospective study was done with patients in our NICU from Jan 2015 to Dec 2017 aged during 29 days to 90 days. We divided them into two groups, 53 of which diagnosed PM were included as a case group, while 81 of which admitted inpatients with fever at the same periods and in the same age ranges were included as a control group. Factors including adverse basic events, clinical manifestations, laboratory examinations and so on were compared between two groups. Results Univariate analysis showed that premature, manifestations such as irritability, lethargy, bulging fontanelle,a stiff neck and the poor circulation, and cerebrospinal fluid(CSF) data like the mount of white blood cell, concentration of CSF protein, concentration of CSF glucose, CSF/blood glucose ratio, concentration of CSF lactate dehydrogenase were different between two groups. In the multivariate analysis, concentration of CSF Protein(＞0.450 g/L, OR=5.819, P=0.002) and concentration of CSF lactate dehydrogenase(＞28.300 U/L,OR=7.892, P＜0.001) were proven to be independent risk factors for the diagnosis of PM. Receiver operating characteristic (ROC) analysis revealed that the CSF protein, the CSF lactate dehydrogenase and the combination of the two factors had an increased area under the curve (AUC), the mounts of each which were 0.839,0.867 and 0.890. Conclusion Patients with PM in early infantile period are often lack of atypical clinical characteristics. We need pay highly attention to the adverse basic events, irritability, lethargy, bulging fontanelle,a stiff neck, poor circulation and CSF results. The independent predictors for early diagnosis were concentration of CSF protein and lactate dehydrogenase. It indicates that if the predictors could be identified early, diagnosis could be made timely and interventions could be operated immediately. It will be beneficial for progression-free and overall survival.

目的 了解化脓性脑膜炎患儿常见后遗症的种类及发生率,探讨可能导致化脓性脑膜炎患儿预后不良的高危因素。方法 选取129例化脑性脑膜炎患儿,患儿分为预后不良组及预后良好组,统计各种后遗症的发生率,并寻找预后不良的危险因素。结果 随访的80例患儿中,有较轻后遗症者12例,有严重后遗症者13例,包括智力低下11例,运动障碍8例,双侧听力障碍4例,继发性癫痫4例,10例患儿合并有两种或以上严重后遗症,最常见为智力低下合并运动障碍。行为问题共检查48例患儿,有行为问题患儿17例。预后不良组和预后良好组在发热总时间>7天、入院后反复抽搐≥3次、昏迷(Glasgow昏迷评分<8分)、感染性休克、瞳孔异常、肢体活动障碍为出现预后不良的危险因素,两组比较差异有统计学意义(P＜ 0.05)。结论 本研究发现,化脓性脑膜炎患儿的后遗症表现多种多样,提示患儿应该进行系统的随访;同时,本研究还发现昏迷、感染性休克等临床症状是导致预后不良的危险因素。早期识别这些症状,并给予早期干预,将对患儿的预后有着重要意义。

Objective To investigate the types and incidence of common sequelae in children with bacterial meningitis.To investigate the risk factors for adverse outcome of childhood bacterial meningitis. Methods Selected 129 children with bacterial meningitis all cases were divided into adverse outcome group and favorable outcome group.According to the incidences of different kinds of sequelae,The risk factor effecting bad prognosis were studied. Results A total of 80 children were successfully followed.Of them,12 might only have mild sequelae and 13 had serious sequelaes.Among these children who had serious sequelae,11 of them had mental retardation,8 of them had motor deficit,4 of them had bilateral hearing loss and 4 of them had secondary epilepsy.10 children had multiple serious sequelae,thes most common multiple impairment combinations were mental retardation plus motor deficit.48 parents of the children completed the Child Behaviour Checklist and found out 17(35.42%)of their children had behavioral disorders.Adverse outcome group and favorable outcome group,the length of fever(>7 days),repeated convulsions after admission(≥3 times),coma(Glasgow coma scale score <8 points),septic shock,abnormal pupils,limb movement disorder.There were significantly difference between the two groups(P＜ 0.05). Conclusions This study showed that there are different kinds of sequelaes of children with bacterial meningitis,it indicated that these children should be follow-up to track the effect.On the other hand,this study found out that the high risk factors with adverse outcome might be coma,septic shock and so on.It indicated that if we could identify the high risk factors in the early stage and then interpose them immediately,it might beneficial to improve the quality of life of the children.