Morita Yuka, Kitazawa Meiko, Yagi Chihiro, Takahashi Kuniyuki, Ohshima Shinsuke, Yamagishi Tatsuya, Izumi Shuji, Horii Arata
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Otol Neurotol. 2022 Sep 1;43(8):e835-e840. doi: 10.1097/MAO.0000000000003610. Epub 2022 Aug 4.
To determine the locations and predictive factors of hypertrophic pachymeningitis (HP), a serious central complication of otitis media with antineutrophil cytoplasmic antigen-associated vasculitis (OMAAV).
Retrospective study.
University hospital.
Thirty-six patients with OMAAV underwent contrast-enhanced magnetic resonance imaging (CE-MRI) of the brain, of whom 18 and 18 had or did not have HP, respectively.
The location of HP lesions, which were detected as dural thickening on CE-MRI, was reviewed. Clinical characteristics, laboratory data, and audiometric data before treatment were correlated with the occurrence of HP.
HP lesions were most frequently observed in the middle cranial fossa, followed by the internal auditory meatus, tentorium cerebelli, and posterior cranial fossa, which were adjacent to the middle ear primary lesion. Headache was more frequently observed in patients with HP than without HP. The neutrophil-to-lymphocyte ratio (NLR) of the HP (+) group (median, 3.91; interquartile range, 2.50-6.06) was higher than that of the HP (-) group (median, 2.40; interquartile range, 2.01-3.03). The area under the receiver operating characteristic curve for the NLR was 0.741. An NLR of 3.46 had the highest sensitivity (61.1%) and specificity (94.4%) for predicting HP. Other markers of systemic inflammation and comorbidities of systemic diseases were not different between the groups.
HP may not be a systemic manifestation of OMAAV but may be related to local lesions in the adjacent brain. A high NLR may be a predictive factor for comorbid HP. Therefore, CE-MRI should be considered for patients with a high NLR.
确定肥厚性硬脑膜炎（HP）的部位及预测因素，HP是抗中性粒细胞胞浆抗原相关性血管炎伴中耳炎（OMAAV）的一种严重中枢并发症。
回顾性研究。
大学医院。
36例OMAAV患者接受了脑部对比增强磁共振成像（CE-MRI）检查，其中18例有HP，18例无HP。
回顾CE-MRI上表现为硬脑膜增厚的HP病变部位。将治疗前的临床特征、实验室数据及听力测定数据与HP的发生情况进行相关性分析。
HP病变最常出现在中颅窝，其次是内耳道、小脑幕和后颅窝，这些部位与中耳原发性病变相邻。有HP的患者比无HP的患者更常出现头痛。HP（+）组的中性粒细胞与淋巴细胞比值（NLR）（中位数为3.91；四分位间距为2.50 - 6.06）高于HP（-）组（中位数为2.40；四分位间距为2.01 - 3.03）。NLR的受试者工作特征曲线下面积为0.741。NLR为3.46时，预测HP的敏感性最高（61.1%），特异性最高（94.4%）。两组间全身炎症的其他标志物及全身性疾病的合并症无差异。
HP可能不是OMAAV的全身性表现，而可能与邻近脑区的局部病变有关。高NLR可能是合并HP的预测因素。因此，对于NLR高的患者应考虑行CE-MRI检查。
