MRI、脑脊液常规对中枢性神经系统感染诊断鉴别价值

目的探究磁共振成像(MRI)、脑脊液常规对中枢性神经系统感染(CNSI)诊断鉴别价值。方法以2018年5月至2020年5月112例CNSI患者为研究对象,并以同期健康体检者56例为对照组。比较两组及不同脑膜炎类型患者的脑脊液指标;比较脑脊液指标及MRI对CNSI的诊断效能,并分析单独检测及联合检测对CNSI的诊断价值及对化脓性脑膜炎、结核性脑膜炎的鉴别价值。结果研究组脑脊液乳酸脱氢酶(LDH)、肌酸激酶(CK)、乳酸(LA)及神经元特异性烯醇化酶(NES)水平均显著高于对照组,化脓性脑膜炎、结核性脑膜炎患者脑脊液LDH、CK、LA水平均高于病毒性脑膜炎患者,NES水平低于病毒性脑膜炎患者(P<0.05);联合检测诊断CNSI及鉴别化脓性脑膜炎、结核性脑膜炎的AUC大于单独检测,联合诊断的灵敏度高于CK、LA,特异度高于NES(P<0.05)。结论MRI及脑脊液指标联合检测对CNSI具有诊断价值,且对化脓性脑膜炎、结核性脑膜炎具有鉴别价值。

Differential Diagnosis Value of MRI and Cerebrospinal Fluid Routine for Central Nervous System Infection

Objective To explore the differential diagnosis value of magnetic resonance imaging(MRI)and cerebrospinal fluid(CSF)routine for central nervous system infection(CNSI).Methods A total of 112 CNSI patients who were treated in the hospital from May 2018 to May 2020 were enrolled as the research objects.Another 56 healthy controls during the same period were enrolled as a control group.CSF indexes were compared between the two groups and among patients with different types of meningitis.The diagnostic efficiency of CSF indexes and MRI for CNSI was compared.The diagnostic value of them alone and their combination for CNSI,as well as their differential value for purulent meningitis and tuberculous meningitis were analyzed.Results The levels of lactate dehydrogenase(LDH),creatine kinase(CK),lactic acid(LA)and neuron-specific enolase(NES)in the CSF of study group were significantly higher than those of the control group.The levels of LDH,CK,and LA in CSF of patients with purulent meningitis and tuberculous meningitis were higher than those of patients with viral meningitis,while level of NES was lower than that of patients with viral meningitis(P<0.05).AUC values of combined detection for diagnosis of CNSI and differential diagnosis of purulent meningitis and tuberculous meningitis were greater than those of them alone.The sensitivity of combined diagnosis was higher than that of CK and LA,and the specificity was higher than that of NES(P<0.05).Conclusion The combined detection of MRI and CSF indexes is of diagnostic value for CNSI,as well as of differential value for purulent meningitis and tuberculous meningitis.