摘要
目的:探索血、脑脊液(CSF)常规及MRI对病毒性、结核性、化脓性及隐球菌性脑膜炎鉴别诊断的意义。方法:回顾性分析病毒性、结核性、化脓性及隐球菌性脑膜炎患者220例的临床资料,筛选出CSF压力、氯化物、蛋白质,血中性粒细胞百分比及有无MRI病灶这5个指标,建立判定函数;比较应用此诊断标准诊断4种脑膜炎的准确性、特异性及敏感性。结果:结核性脑膜炎的约登指数为0.423,敏感性为61.7%,特异性为80.6%,ROC曲线下面积为0.902;病毒性脑膜炎的约登指数为0.425,敏感性为67.5%,特异性为75.0%,ROC曲线下面积为0.855;化脓性脑膜炎的约登指数为0.390,敏感性为65.6%,特异性为73.4%,ROC曲线下面积为0.754;隐球菌性脑膜炎的约登指数为0.194,敏感性为62.5%,特异性为56.9%,曲线下面积为0.705。结论:结合CSF压力、氯化物及蛋白含量,血中性粒细胞百分比及有无MRI病灶建立判别函数可以提高脑膜炎的早期诊断正确率,但确诊仍需病原学检测结果。
Objective： To explore the role of routine blood test, cerebrospinal fluid（CSF） test and MRI in differential diagnosis of viral meningitis, tubercular meningitis, purulent meningitis and cryptococcal meningitis. Methods：A retrospective study of 220 patients with viral meningitis, tubercular meningitis, purulent meningitis and cryptococcal meningitis was carried out. The data of CSF pressure, chloride and protein content, neutrophil percent of blood and MRI was collected to establish a discriminant function. The accuracy, specificity and sensitivity of this discriminant function to diagnosis the four types of meningitis were assessed. Results： The Youden index, sensitivity, specificity and area under ROC curve of the discriminant functions were 0.423, 61.7%, 80.6% and 0.902 in tubercular meningitis; 0.425, 67.5%, 75.0% and 0.855 in viral meningitis; 0.390, 65.6%, 73.4% and 0.754 in purulent meningitis; 0.194, 62.5%, 56.9% and 0.705 in cryptococcal meningitis. Conclusion： The discriminant function is valuable for the differential diagnosis of viral meningitis, tubercular meningitis, purulent meningitis and cryptococcal meningitis, while the final diagnosis is still based on the etiology.
出处
《神经损伤与功能重建》
2015年第3期213-215,共3页
Neural Injury and Functional Reconstruction
关键词
脑膜炎
脑脊液
核磁共振
meningitis
cerebrospinal fluid
magnetic resonance imaging
