结核性脑膜炎患者脑脊液乳酸水平与颅脑MRI表现及预后的关系

doi:10.19871/j.cnki.xfcrbzz.2025.06.010

摘要/Abstract

摘要： 目的探讨结核性脑膜炎（tubercular meningitis,TBM）患者脑脊液（cerebrospinal fluid,CSF）乳酸水平与颅脑磁共振成像（magnetic resonance imaging,MRI）表现及预后的相关性,为TBM诊断及预后提供参考。方法本研究采用回顾性分析方法,纳入重庆医科大学附属大足医院2020年1月至2023年2月收治的48例TBM患者,对其随访6个月。临床不良结局为入院后6个月死亡或严重残疾,将死亡或严重残疾的患者纳入不良结局组（n=16）,格拉斯哥预后评分（Glasgow outcome scale,GOS）为4或5分的患者纳入良好结局组（n=32）,比较两组患者一般资料和入院48h内CSF乳酸水平,通过多因素Logistic回归分析患者CSF乳酸水平与MRI表现及临床结局的相关性。结果与良好结局组相比,不良结局组的CSF乳酸水平显著升高[（4.07±2.42）mmol/L比（6.59±3.44）mmol/L,t=2.946,P=0.005]。受试者操作特征曲线分析结果显示,CSF乳酸水平预测TBM患者6个月临床结局的曲线下面积为0.838（95%CI：0.688~0.988）,在最佳截断点（4.36mmol/L）处,预测的敏感度、特异度分别为87.5%、84.4%。多因素Logistic分析结果显示,CSF乳酸水平>4.36mmol/L为TBM患者6个月内死亡的独立危险因素。CSF乳酸水平>4.36mmol/L的TBM患者更易出现基底节区梗死、丘脑梗死、小脑梗死以及脑积水MRI表现（P<0.05）。结论 CSF乳酸水平>4.36mmol/L的TBM患者更易出现脑梗死、脑积水MRI表现,该指标也是TBM患者6个月内死亡的独立危险因素,是评估TBM患者预后的重要指标。

关键词: 脑脊液乳酸, 结核性脑膜炎, 磁共振成像, 影像学表现, 预后

Abstract: Objective To explore the correlation between lactate level of cerebrospinal fluid (CSF) and cranial magnetic resonance imaging (MRI) manifestations and prognosis of tuberculous meningitis (TBM) patients, so as to provide a basis for diagnosis and prognosis of TBM. Method This study adopted a retrospective analysis method. A total of 48 patients with TBM admitted to Chongqing Dazu District People's Hospital from January 2020 to February 2023 were included and followed up for 6 months. The adverse clinical outcome was death or severe disability 6 months after admission. Patients with death or severe disability were included in the adverse outcome group (n=16), and patients with a Glasgow outcome scale (GOS) of 4 or 5 were included in the good outcome group (n=32). All patients underwent MRI examination, and CSF lactate levels were analyzed by automatic biochemical analyzer. Result Compared with the good outcome group, the CSF lactate level in the bad outcome group was significantly higher [(4.07±2.42)mmol/L vs (6.59±3.44)mmol/L, t=2.946, P=0.005]. Receiver operating characteristic curve analysis showed that CSF lactate level predicted 6-month clinical outcome of TBM patients with an area under the curve of 0.838 (95% CI: 0.688-0.988) at the optimal cut-off value (4.36 mmol/L), the sensitivity and specificity of the prediction were 87.5% and 84.4%, respectively. Multivariate Logistics analysis determined that CSF lactate level >4.36 mmol/L was an independent risk factor for death in TBM patients within 6 months. TBM patients with CSF lactate level >4.36 mmol/L were more likely to have MRI findings of basal ganglia region, thalamus, cerebellum cerebral infarction and hydrocephalus (P<0.05). Conclusion TBM patients with a CSF lactate level >4.36 mmol/L of admission are more likely to present with cerebral infarction and hydrocephalus findings on MRI. This indicator is also an independent risk factor for mortality within 6 months in TBM patients, and serves as an important indicator for assessing the prognosis of TBM patients.

Key words: Cerebrospinal fluid lactate, Tuberculous meningitis, Magnetic resonance imaging, Imaging manifestations, Prognosis

中图分类号:

R52
R529.3

黄志强, 吴绍全, 周帮建, 田永攀, 吴继祥, 彭云航. 结核性脑膜炎患者脑脊液乳酸水平与颅脑MRI表现及预后的关系[J]. 新发传染病电子杂志, 2025, 10(6): 63-69.

Huang Zhiqiang, Wu Shaoquan, Zhou Bangjian, Tian Yongpan, Wu Jixiang, Peng Yunhang. Relationship between cerebrospinal fluid lactate level and craniocerebral MRI findings and prognosis of tuberculous meningitis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(6): 63-69.

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