77例脑膜癌病患者的回顾性分析

77例脑膜癌病患者的回顾性分析
2017/6/26 创新医学网

文章来源：欧尔意 OAE微信号作者：Sofina

     原文出处

     Chu FN, Lang Y, Sun XM, Cui L. Meningeal carcinomatosis: a retrospective analysis of seventy-seven cases. Neuroimmunol Neuroinflammation 2017;4:1-5.

     DOI:10.20517/2347-8659.2016.23

     摘要

     目的：归纳脑膜癌病的临床、实验室及影像学检查特点，提高早期诊断率，改善预后。方法：以77例脑膜癌病病例为研究对象，对入组病例临床特点，影像学检查，血清肿瘤标志物，治疗方法及患者生存时间等进行数据统计并加以分析。结果：男女均可发病，中位发病年龄为55岁，多以急性(46.2%)或亚急性(39%)起病。首发症状头痛、恶心呕吐等颅内压增高症状占70.1%。腰椎穿刺颅内压测定，压力升高者占56%，其中大于400mmH2O者占21.1%。患者脑脊液常规生化检查异常者95.3%，其中蛋白升高者73.4%，细胞数增多者57.1%，48.4%患者脑脊液糖降低。脑脊液细胞学首次腰椎穿刺阳性率82.2%，复查脑脊液细胞学可提高阳性率。本研究中3例患者行脑脊液肿瘤标志物检查，均存在异常。患者头MRI平扫发现脑膜异常者占13.2%，增强扫描脑膜强化占35.3%。血清肿瘤标志物异常者占84%。脑电图无明显特异性。原发肿瘤中肺癌58.3%(35例)，胃癌16.7%(10例)，乳腺癌10%(6例)，黑色素细胞瘤5%(3例)，非霍奇金淋巴瘤3.3%(2例)，卵巢癌、结肠癌、鼻咽癌、急性淋巴细胞性白血病分别为1.7%(1例)，22.1%(17例)未发现原发肿瘤。58.4%(45例)患者发病前未发现肿瘤的存在，而41.6%(32例)的患者则存在原发肿瘤。进行鞘内注射化疗及全脑部放疗患者生存期与仅给予对症支持治疗患者生存期无明显差异。结论： 1、脑膜癌病患者任何年龄均可发病，急性或亚急性起病，平均年龄为55岁。2、脑膜癌病患者临床表现以头痛、恶心、呕吐等颅内压增高症状为首发症状且最多见。3、脑脊液颅内压增高，蛋白升高，白细胞轻度升高，以单核细胞为主，细胞学发现异常细胞为诊断金标准。4、头MRI增强扫描脑膜线形强化具有重要价值。5、原发肿瘤以肺癌最多见，其次为胃癌、乳腺癌等。

     Aim: Meningeal carcinomatosis is a special type of malignant tumor characterized by short survival and poor prognosis. In the present study, the authors aim to analyze the clinical, laboratory data and prognosis of meningeal carcinomatosis patients.Methods: The authors enrolled 77 cases of meningeal carcinomatosis from 2003 to 2013 in the First Hospital of Jilin University. The clinical data including age, gender, symptoms at onset, clinical manifestations, primary tumors and the laboratory data including cerebrospinal fluid (CSF), tumor markers as well as the imaging data were analyzed. The interval between the onset of primary tumor and the onset of central nervous symptoms, treatments and survival time were also analyzed. Results: The onset of meningeal carcinomatosis was usually acute (46.2%) or subacute (39.0%). The most frequent symptom at onset was intracranial hypertension (70.1%). Symptoms such as headache, vomit and high lumbar puncture intracranial pressure was observed in 56% of cases during the course of the disease. CSF abnormalities such as higher protein concentration (73.4%), more CSF pleocitosis (57.1%) and lower glucose levels (48.4%) were found in 95.3% of meningeal carcinomatosis patients. Non-contrast enhanced cerebral magnetic resonance imaging (MRI) showed that 13.2% patients had abnormal meningeal changes while in the enhancement scan 35.3% patients showed changes. The serum tumor markers increased in 84% of the patients. There were no differences regarding the mean survival between patients who received intrathecal chemotherapy and those who received brain radiotherapy or supportive treatment. Conclusion: The most common clinical manifestation of meningeal carcinomatosis is intracranial hypertension. The most common primary tumor is lung cancer, followed by gastric cancer and breast cancer. The linear enhancement of meningeal on the MRI scan is of great importance for the diagnosis of meningeal carcinomatosis.

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