Department of Radiology, Beijing Youan Hospital Affiliated to Capital Medical University, Beijing 100069, China.
Department of Radiology, Tianjin First Central Hospital, Tianjin 300192, China.
Chin Med J (Engl). 2018 Dec 20;131(24):2930-2937. doi: 10.4103/0366-6999.247201.
The incidence of cryptococcal meningitis among immunocompetent patients increases, especially in China and imaging plays an important role. The current study was to find the correlation between magnetic resonance imaging (MRI) manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS).
A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study. All the patients had MRI data and clinical data. The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease. Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t- test, Chi-square test, Mann-Whitney test and Spearman rank correlation analysis.
In all 65 patients, 41 cases (41/65, 63.1%; Group 1) had normal immunity and 24 cases (24/65, 36.9%; Group 2) had at least one identifiable underlying disease. Fever, higher percentage of neutrophil (NEUT) in white blood cell (WBC), and increased cell number of cerebral spinal fluid (CSF) were much common in patients with underlying disease (Group 1 vs. Group 2: Fever: 21/41 vs. 21/24, χ = 8.715, P = 0.003; NEUT in WBC: 73.15% vs. 79.60%, Z = -2.370, P = 0.018; cell number of CSF: 19 vs. 200, Z = -4.298, P < 0.001; respectively). Compared to the patients with normal immunity, the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs. Group 2: 20/41 vs. 20/24, χ = 7.636, P = 0.006). The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r = -0.472, P = 0.031; r = 0.779, P = 0.039; respectively).
With the increased number of the involved brain areas in patients with identifiable underlying disease, the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.
免疫功能正常患者中隐球菌性脑膜炎的发病率增加，尤其是在中国，影像学发挥着重要作用。本研究旨在寻找非人类免疫缺陷病毒（HIV）患者中枢神经系统（CNS）隐球菌感染的磁共振成像（MRI）表现与临床严重程度之间的相关性。
回顾性纳入 2014 年 8 月至 2016 年 10 月间 65 例 CNS 隐球菌感染患者，所有患者均有 MRI 数据和临床数据。根据患者是否有明确的潜在疾病，将患者分为两组。采用独立样本 t 检验、卡方检验、Mann-Whitney 检验和 Spearman 秩相关分析比较两组的 MRI 和临床资料，并进行相关性分析。
在所有 65 例患者中，41 例（41/65，63.1%；组 1）免疫功能正常，24 例（24/65，36.9%；组 2）至少有一种明确的潜在疾病。有潜在疾病的患者发热、白细胞（WBC）中性粒细胞（NEUT）百分比较高、脑脊液（CSF）细胞数增加（组 1 与组 2：发热：21/41 与 21/24，χ=8.715，P=0.003；WBC 中的 NEUT：73.15%与 79.60%，Z=-2.370，P=0.018；CSF 细胞数：19 与 200，Z=-4.298，P<0.001；分别）。与免疫功能正常的患者相比，有明确潜在疾病的患者基底节区病变更常见（组 1 与组 2：20/41 与 20/24，χ=7.636，P=0.006）。有明确潜在疾病的患者受累脑区数量与 CSF 细胞数和压力呈负相关（r=-0.472，P=0.031；r=0.779，P=0.039；分别）。
随着有明确潜在疾病的患者受累脑区数量的增加，机体对该病原体的免疫力下降，可能导致颅内压升高和更严重的临床状态。
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