空军医学杂志
空軍醫學雜誌
공군의학잡지
Medical Journal of Air Force
2015年
3期
144-146
,共3页
航空医学%脑胶质瘤病%飞行人员%合格鉴定
航空醫學%腦膠質瘤病%飛行人員%閤格鑒定
항공의학%뇌효질류병%비행인원%합격감정
Aviation medicine%Gliomatosis cerebri%Aircrew%Identify
目的：探讨飞行人员患罕见病脑胶质瘤病（gliomatosis cerebri，GC）的发病机制、诊断、治疗，分析恶性肿瘤与飞行的关系及健康鉴定。方法分析1例飞行人员的临床资料及复习相关文献。结果本例亚急性起病，特征性不强，起始症状、体征不明显，缓慢进行性加重。入院前1个月内4次跌倒有可能是失张力性癫痫发作，入院1周后1 d内出现4次不同类型癫痫发作，并出现癫痫持续状态，癫痫发作为该患者主要特点。头颅磁共振成像病变范围广，脑室周较对称，白质为主，灰质亦受累，增强无强化，占位效应不明显。排除了颅内感染、多发性硬化等其他疾病。脑活检（取颞叶）病理为胶质母细胞瘤。肿瘤细胞免疫组化：GFAP（+++），Olig-2（+++），S-100（+），MGMT（++）。综合多种因素，确诊为脑胶质瘤病，替莫唑胺及贝伐单抗治疗6个月，缓慢进行性加重，肿瘤压迫致左侧侧脑室消失，已行手术减压，预后差。结论脑胶质瘤病起始表现隐袭，飞行人员体质强，发病后临床表现不易察觉。这就对临床航空医生提出更高的要求，对临床表现及检查、检验结果认真观察分析，尽早做出诊断，避免误诊。对飞行人员恶性肿瘤的飞行结论要根据病情轻重、飞行机种及飞行任务综合评定。
目的：探討飛行人員患罕見病腦膠質瘤病（gliomatosis cerebri，GC）的髮病機製、診斷、治療，分析噁性腫瘤與飛行的關繫及健康鑒定。方法分析1例飛行人員的臨床資料及複習相關文獻。結果本例亞急性起病，特徵性不彊，起始癥狀、體徵不明顯，緩慢進行性加重。入院前1箇月內4次跌倒有可能是失張力性癲癇髮作，入院1週後1 d內齣現4次不同類型癲癇髮作，併齣現癲癇持續狀態，癲癇髮作為該患者主要特點。頭顱磁共振成像病變範圍廣，腦室週較對稱，白質為主，灰質亦受纍，增彊無彊化，佔位效應不明顯。排除瞭顱內感染、多髮性硬化等其他疾病。腦活檢（取顳葉）病理為膠質母細胞瘤。腫瘤細胞免疫組化：GFAP（+++），Olig-2（+++），S-100（+），MGMT（++）。綜閤多種因素，確診為腦膠質瘤病，替莫唑胺及貝伐單抗治療6箇月，緩慢進行性加重，腫瘤壓迫緻左側側腦室消失，已行手術減壓，預後差。結論腦膠質瘤病起始錶現隱襲，飛行人員體質彊，髮病後臨床錶現不易察覺。這就對臨床航空醫生提齣更高的要求，對臨床錶現及檢查、檢驗結果認真觀察分析，儘早做齣診斷，避免誤診。對飛行人員噁性腫瘤的飛行結論要根據病情輕重、飛行機種及飛行任務綜閤評定。
목적：탐토비행인원환한견병뇌효질류병（gliomatosis cerebri，GC）적발병궤제、진단、치료，분석악성종류여비행적관계급건강감정。방법분석1례비행인원적림상자료급복습상관문헌。결과본례아급성기병，특정성불강，기시증상、체정불명현，완만진행성가중。입원전1개월내4차질도유가능시실장력성전간발작，입원1주후1 d내출현4차불동류형전간발작，병출현전간지속상태，전간발작위해환자주요특점。두로자공진성상병변범위엄，뇌실주교대칭，백질위주，회질역수루，증강무강화，점위효응불명현。배제료로내감염、다발성경화등기타질병。뇌활검（취섭협）병리위효질모세포류。종류세포면역조화：GFAP（+++），Olig-2（+++），S-100（+），MGMT（++）。종합다충인소，학진위뇌효질류병，체막서알급패벌단항치료6개월，완만진행성가중，종류압박치좌측측뇌실소실，이행수술감압，예후차。결론뇌효질류병기시표현은습，비행인원체질강，발병후림상표현불역찰각。저취대림상항공의생제출경고적요구，대림상표현급검사、검험결과인진관찰분석，진조주출진단，피면오진。대비행인원악성종류적비행결론요근거병정경중、비행궤충급비행임무종합평정。
ObjectiveTo investigate the pathogenesis, diagnosis and treatment of aircrew with GC, to inquire into the relations of malignancy with flying and the criteria of individual aero medical evaluation.MethodsThe clinical data of 1case of aircrew with gliomatosis cerebri was analyzed and related literatures were reviewed.ResultsThe clinical manifestations were subacute onset. The initial symptoms and signs were not obvious, and the disease progresses more slowly. The patient fell down 4 times before pre hospital, which may be atonic seizures, and presented four different types of seizures, even found status epilepticusa in a day after admission. Seizures was the main characteristics of the patient. There was extensive head lesion in MRI, periventricular relatively symmetrical, and white matter was mainly involved, gray matter was also involved. There was no obvious enhancement. Intracranial infection, multiple sclerosis and other diseases were excluded. Brain biopsy was pathology of glioblastoma. Tumor cells by immunohistochemistry were GFAP(+++), Olig-2(+++), S-100 (+), MGMT(++). In view of comprehensive variety of factors, the patient was diagnosed as glioma disease. Temozolomide and bevacizumab were used to treat for six months, caused slower progression. Cancer caused the left lateral ventricle disappeared. The patient treated by core decompression had a poor prognosis.ConclusionThe clinical features of GC at early stage were obscure. The situation was more obvious in the aircrew because the health quality of aircrew is usually excellent before illness. Aviation physicians should raise the recognition level of the early features of GC so as to prevent wrong diagnosis. Aero medical assessment of flying personnel with malignancy should be evaluated according to clinical features, aircraft types and flight duties.
