Relationship between cerebrospinal fluid polymorphonuclear neutrophils and brain MRI manifestations and prognosis in patients with tuberculous meningitis
Objective To investigate the relationship between cerebrospinal fluid polymorphonuclear neutrophils(CSF PMN)levels and brain magnetic resonance imaging(MRI)performance and prognosis in patients with tuberculous meningitis(TBM).Methods Retrospective analysis of data from 48 TBM patients admitted to the neurology department of Heze Municipal Hospital from April 2022 to October 2023.All patients underwent baseline cranial MRI examination and CSF analysis.The primary endpoint of this study was functional recovery and survival status at 6 months,while the secondary endpoint was whether MRI findings worsened after 2 months of intensive treatment.Analyze the relationship between CSF PMN levels,MRI findings,and prognosis.Results Sixteen patients had poor recovery(Glasgow prognosis score 3)at 6 months,comprising 11 deaths and 5 severely disabled patients.Of the surviving patients,29 patients experienced deterioration in MRI at 2 months.Compared with the patients with good recovery at 6 months,the CSF PMN level and the number of abnormal MRI findings in the patients with poor recovery were significantly increased(P＜0.05),especially the proportion of patients with cerebral infarction and cranial nerve enhancement on MRI was increased(P＜0.05).Binary logistic multifactorial showed that both MRI abnormal manifestations＞3 and CSF PMN≥47.50％were independent influences on poor recovery in patients with TBM(P＜0.05).The receiver operating characteristic results showed that the area under the curve for MRI abnormal manifestations,CSF PMN,and the combination of the two in predicting the recovery of the patients at 6 months was 0.824(95％CI:0.703-0.945),0.819(95％CI:0.695-0.943),0.887(95％CI:0.795-0.978),all P＜0.001.Compared with surviving patients,the number of abnormal MRI findings and CSF PMN levels were significantly increased in deceased patients(P＜0.05).Moreover,the patients with severe survival and worsening MRI almost had more abnormal MRI findings and CSF PMN levels(P＜0.05).Conclusion CSF PMN combined with baseline MRI performance has a high predictive value for the prognosis of patients with TBM,when the more complex cerebral abnormalities and higher levels of CSF PMN are demonstrated by MRI at baseline,it predicts a poorer prognosis for the patient.
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