本文選題：肥厚性硬腦膜炎　切入點(diǎn)：E-B病毒　出處：《山東大學(xué)》2014年碩士論文

【摘要】：目的結(jié)合國(guó)內(nèi)外相關(guān)文獻(xiàn)探討肥厚性硬腦膜炎的流行病學(xué)特點(diǎn)、病因及分類(lèi)、臨床表現(xiàn)、實(shí)驗(yàn)室檢查特點(diǎn)、影像學(xué)特點(diǎn)、病理學(xué)特點(diǎn)、診斷及鑒別診斷、治療與預(yù)后等。肥厚性硬腦膜炎為臨床罕見(jiàn)病、少見(jiàn)病,本文的目的為提高臨床醫(yī)生對(duì)此病的認(rèn)識(shí),系統(tǒng)了解本病相關(guān)特點(diǎn),減少誤診率及漏診率,改善臨床治療效果。 方法報(bào)告本院收治的1例肥厚性硬腦膜炎患者的臨床資料,回顧性分析本患者的發(fā)病過(guò)程、臨床表現(xiàn)、影像特點(diǎn)、治療經(jīng)過(guò)、疾病轉(zhuǎn)歸的相關(guān)情況。并系統(tǒng)復(fù)習(xí)國(guó)內(nèi)外相關(guān)文獻(xiàn),對(duì)肥厚性硬腦膜炎的流行病學(xué)特點(diǎn)、病因及分類(lèi)、臨床表現(xiàn)、實(shí)驗(yàn)室檢查特點(diǎn)、影像學(xué)特點(diǎn)、病理學(xué)特點(diǎn)、診斷及鑒別診斷、治療與預(yù)后等方面進(jìn)行系統(tǒng)討論。 結(jié)果本例患者因“無(wú)明顯誘因陣發(fā)性頭痛6年,復(fù)視1月”入院�；颊哂�6年前始無(wú)明顯誘因出現(xiàn)間斷性頭痛,間隔時(shí)間由數(shù)月至數(shù)年不等,每次發(fā)作呈持續(xù)性脹痛,以后枕部、頂部為重,期間有數(shù)次“癲癇大發(fā)作”�；颊哂�1月前再次無(wú)明顯誘因出現(xiàn)頭痛、復(fù)視、吞咽不暢,此次發(fā)病無(wú)癲癇發(fā)作。查體左眼視力較右眼弱(右眼1.0,左眼0.6)；左側(cè)、正前方向視物復(fù)視,右側(cè)方向視物無(wú)復(fù)視,左眼球外展運(yùn)動(dòng)稍受限；右側(cè)眼裂以下面部皮膚感覺(jué)稍遲鈍；咽反射遲鈍。實(shí)驗(yàn)室檢查結(jié)果：血沉：33mm/h(2-20),腦脊液白細(xì)胞計(jì)數(shù)27x106/L(0-8),潘氏實(shí)驗(yàn)(+),腦脊液蛋白0.74g/L(0.00-0.40),腦脊液病毒-DNA:3140IU/ml(50為陽(yáng)性),C反應(yīng)蛋白12.60mg/L(0.00-7.00)。顱腦CT顯示小腦幕區(qū)及后縱裂高信號(hào),腦磁共振示局部硬腦膜異常增生并強(qiáng)化,營(yíng)養(yǎng)神經(jīng)藥物治療后病情得以控制。 結(jié)論肥厚性硬腦膜炎為臨床少見(jiàn)病,國(guó)內(nèi)外文獻(xiàn)多以個(gè)案報(bào)道為主,臨床表現(xiàn)多樣,缺乏特異性癥狀,易漏診、誤診。此病男性多見(jiàn),好發(fā)年齡為40-60歲。按其病因分：特發(fā)性HCP(idiopathic HCP, IHCP)和繼發(fā)性HCP(secondary HCP, SHCP)。首發(fā)癥狀常為頭痛,其他表現(xiàn)有腦神經(jīng)受損癥狀、共濟(jì)失調(diào)、顱內(nèi)動(dòng)脈閉塞、靜脈竇血栓、腦積水、癲癇、精神癥狀等。實(shí)驗(yàn)室檢查白細(xì)胞計(jì)數(shù)及百分比增加、血沉(ESR)輕度增快、髓過(guò)氧化物嗜中性粒細(xì)胞胞漿抗體(MPO-ANCA)陽(yáng)性、類(lèi)風(fēng)濕因子(RF)陽(yáng)性、C反應(yīng)蛋白(CRP)輕度增高較為常見(jiàn)。CT平掃可表現(xiàn)出高密度的增生肥厚的硬腦膜,MRI平掃可見(jiàn)彌漫性增厚的硬腦膜,增厚的硬腦膜在T1WI呈等或低信號(hào),在T2WI呈低信號(hào),其周邊可見(jiàn)高信號(hào)影。病理學(xué)檢查可見(jiàn)硬腦膜呈明顯的纖維性增生,并可見(jiàn)玻璃樣變性,還可見(jiàn)中性粒細(xì)胞、淋巴細(xì)胞、漿細(xì)胞等大量炎性細(xì)胞浸潤(rùn)。此外還可見(jiàn)由多核巨細(xì)胞、纖維母細(xì)胞、上皮細(xì)胞構(gòu)成的肉芽腫。病理學(xué)檢查還可能發(fā)現(xiàn)相關(guān)細(xì)菌、病毒、真菌等代謝活動(dòng)中產(chǎn)生的特異性物質(zhì)及特異性結(jié)構(gòu)。部分患者病情可呈發(fā)病-緩解-發(fā)病-再緩解的規(guī)律,但總體病情常呈加重趨勢(shì),大部分病例經(jīng)藥物或手術(shù)治療后可病情緩解,且隨訪顯示�？删S持較長(zhǎng)時(shí)間,但仍有部分病例臨床干預(yù)無(wú)效,病情在短時(shí)間進(jìn)行性加重,甚至死亡。
[Abstract]:Objective To study the epidemiological characteristics , etiology , classification , pathological characteristics , diagnosis and differential diagnosis , pathology , diagnosis and differential diagnosis , treatment and prognosis of hypertrophic hard meningitis . The aim of this paper is to improve the clinical doctors ' understanding of the disease , to understand the relevant characteristics of the disease , to reduce the misdiagnosis rate and the missed diagnosis rate , and to improve the clinical treatment effect .

Methods The clinical data of 1 patient with hypertrophic and hard meningitis treated in our hospital were analyzed retrospectively . The incidence , clinical manifestation , image characteristics , treatment and prognosis of the patients were analyzed retrospectively . The epidemiological characteristics , etiology , classification , clinical manifestation , laboratory examination characteristics , imaging characteristics , pathological characteristics , diagnosis and differential diagnosis , treatment and prognosis of hypertrophic hard meningitis were reviewed .

Results In this case , the patient was admitted to the hospital for 6 years without obvious induced paroxysmal headache . The patient had no obvious cause of intermittent headache at the beginning of 6 years . The interval was prolonged from several months to several years .
The left , right front , and right direction were diplopia , and the left eyeball abduction movement was slightly limited .
The following facial skin feels slightly obtuse under the right eye ;
The results of laboratory examination were : ESR : 33mm / h ( 2 - 20 ) , white blood cell count 27x106 / L ( 0 - 8 ) , Pan ' s experiment ( + ) , cerebrospinal fluid protein 0.74g / L ( 0.00 - 0.40 ) , cerebrospinal fluid virus - DNA : 3140IU / ml ( 50 % positive ) , C - reactive protein 12.60 mg / L ( 0.00 - 7.00 ) . Brain CT showed small brain curtain region and posterior longitudinal fissure high signal , and brain magnetic resonance showed abnormal hyperplasia of dura mater and strengthened .

Conclusion Hypertrophic hard meningitis is rare in clinic . There are many cases reported in domestic and foreign literatures . The clinical manifestations are diverse , lack of specific symptoms , easy leakage diagnosis and misdiagnosis . For men with this disease , the age is 40 - 60 years old . According to the etiology , idiopathic HCP , IHCP and secondary HCP ( SHCP ) are classified . The results showed that there was a significant increase in the number and percentage of white blood cells ( ESR ) , mild increase of ESR , and mild increase of C - reactive protein ( CRP ) .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R512.3

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