本文關(guān)鍵詞： 脫髓鞘假瘤 膠質(zhì)瘤 臨床分析 鑒別診斷　出處：《臨床神經(jīng)病學(xué)雜志》2017年03期 　論文類型：期刊論文

【摘要】：目的探討CNS脫髓鞘假瘤(DPT)的臨床特點,并與膠質(zhì)瘤進(jìn)行鑒別,以提高對DPT的認(rèn)識。方法收集均經(jīng)病理證實的13例DPT和17例膠質(zhì)瘤患者的臨床資料,對比二者之間的臨床、影像學(xué)、實驗室檢查及病理特點,并分析DPT的治療與轉(zhuǎn)歸。結(jié)果 DPT組平均發(fā)病年齡高于膠質(zhì)瘤組(P0.05)。DPT組女性多見,膠質(zhì)瘤組無明顯性別差異。DPT組急性或亞急性起病(76.9%)常見,膠質(zhì)瘤組慢性起病常見(70.5%)。DPT組首發(fā)癥狀以頭痛(38.4%)多見,膠質(zhì)瘤組以頭痛(41.1%)、癇性發(fā)作(23.5%)多見。DPT組影像學(xué)部分病灶可見"垂直征"及特異性"開環(huán)征",DWI高b值呈高信號,膠質(zhì)瘤DWI高b值多呈低信號。MRS檢查出現(xiàn)特異性β,γ-谷氨酸復(fù)合物(Glx)峰升高可與膠質(zhì)瘤進(jìn)行鑒別。兩組CSF壓力、蛋白相比差異有統(tǒng)計學(xué)意義(均P0.05)。病理活組織檢查出現(xiàn)特異性核分裂狀的Creutzfeldt細(xì)胞及CD68免疫組化染色陽性有助于兩者鑒別診斷。經(jīng)激素治療后DPT大部分病灶明顯縮小或消失,部分可發(fā)展為多發(fā)性硬化。結(jié)論DPT在臨床表現(xiàn)及影像學(xué)等方面與膠質(zhì)瘤相似。影像學(xué)檢查出現(xiàn)"垂直征"、"開環(huán)征"及β,γ-Glx峰升高可能具有特異性,DWI/MRS檢查有助于鑒別膠質(zhì)瘤。激素實驗性治療可能有助于鑒別病變性質(zhì),但最終確診仍需病理結(jié)果,部分可發(fā)展為多發(fā)性硬化。
[Abstract]:Objective to investigate the clinical features of CNS demyelinating pseudotumor and to differentiate it from glioma in order to improve the understanding of DPT. Methods the clinical data of 13 cases of DPT and 17 cases of glioma confirmed by pathology were collected and compared. Results the average age of onset of DPT in DPT group was higher than that in glioma group P0.05. DPT group was more common than that in glioma group, and there was no significant gender difference in glioma group. In the glioma group, the most common symptoms of chronic onset were headache 38.4% in DPT group, 41.1% in glioma group and 23.5% in epileptic seizure group. In the DPT group, "vertical sign" and specific "open loop sign" were found in high signal intensity on DWI. The high b value of DWI in gliomas was low signal. Mrs examination showed specific 尾, 緯 -glutamate complex Glx peak elevation could be distinguished from gliomas. The CSF pressure in the two groups was higher than that in the control group. There was a significant difference in protein between the two groups (all P 0.05). The presence of specific mitotic Creutzfeldt cells and positive CD68 immunohistochemical staining were helpful in differential diagnosis. Most of the lesions of DPT were significantly reduced or disappeared after hormone therapy. Conclusion DPT is similar to glioma in clinical manifestation and imaging. The "open loop sign" and the elevation of 尾, 緯 -Glx peak may be specific for differential diagnosis. Glioma. Experimental hormone therapy may help to differentiate the nature of the lesion, But the final diagnosis still needs pathological results, some of which can develop into multiple sclerosis.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科;河南科技大學(xué)第一附屬醫(yī)院腫瘤內(nèi)科;
【分類號】：R739.4

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