结核性脑膜脑炎脑脊液细胞学动态分析及其诊断价值

目的探讨脑脊液细胞学特点在结核性脑膜脑炎临床诊断中的价值。方法运用玻片细胞沉淀（粟秀初教授研制）细胞学方法,对72例结核性脑膜脑炎患者的脑脊液细胞学分类特点进行动态观察与分析,以评估治疗效果。结果结核性脑膜脑炎患者脑脊液白细胞总数升高。早期嗜中性粒细胞增高,随后呈混合型细胞反应,随着病情的好转,嗜中性粒细胞逐渐消失,以淋巴、单核细胞为主。结论脑脊液细胞学检查操作简便,结果确切,有一定特异性,对结核性脑膜脑炎的临床诊断具有辅助价值。     

非感染性异常脑膜强化的磁共振成像诊断

磁共振成像(MRI)自应用于临床以来,使脑膜疾病诊断的敏感性大大提高,已成为诊断脑膜疾病的主要影像学检查手段.脑膜强化最常见于感染性脑膜炎,临床上采取影像学检查结合脑脊液检查较易确诊.然而,多种非感染性中枢神经系统病变也可以致脑膜异常强化,同时脑脊液检查又缺乏特异性,使诊断较为困难[1-4].我们回顾性分析了23例非感染性异常脑膜强化患者的MRI表现,以协助其病因诊断.     

脑脊液细胞学检查和病毒抗体检测对病毒性脑膜脑炎的诊断价值

目的:探讨脑脊液细胞学检测和病毒抗体检测对病毒性脑膜脑炎的诊断价值。方法:选择84例颅内感染患者分为:病毒性脑膜脑炎组32例,结核性脑膜脑炎组32例,化脓性脑膜脑炎组20例。结核性脑膜脑炎组和化脓性脑膜脑炎组作为对照。每例患者各取2次脑脊液,共168份脑脊液。分别行细胞学检测和ELISA法检测病毒系列抗体IgG、IgM。结果:病毒性脑膜脑炎的脑脊液细胞学超早期有明显的嗜中性粒细胞反应,随后出现激活的淋巴细胞反应;随着患者病情好转,激活的淋巴细胞逐渐减少;转而以淋巴细胞、单核细胞为主。病毒抗体IgG检测:病毒性脑膜脑炎组阳性率为86.7%,明显高于结核性脑膜脑炎组(48.3%)和化脓性脑膜脑炎组(15%);抗体IgM检测:病毒性脑膜脑炎组与结核性脑膜脑炎组和化脓性脑膜脑炎组比差异无统计学意义。结论:脑脊液细胞学检查快速、简便,是中枢神经系统病毒感染的重要指标之一;病毒特异性IgG抗体诊断病毒性脑膜脑炎的敏感度为54.7%,特异度为91.3%,是确诊病毒性脑膜脑炎病原的方法之一。     

脑脊液基因组测序诊断特殊链球菌脑膜脑炎

血链球菌脑膜脑炎为罕见病例,快速诊断血链球菌脑膜脑炎是临床治疗该疾病的关键。然而,目前的诊断技术并不支持对这种疾病的早期诊断。脑脊液基因组测序是一种早期诊断中枢神经系统感染的很有前途的方法。据笔者所知,在血链球菌脑膜脑炎的诊断中使用脑脊液基因组测序的报道很少。现报告1例血链球菌脑膜脑炎的45岁男性患者,患者发病前无明显诱因。常规检查,包括革兰染色和脑脊液培养,未发现细菌感染。然而,应用脑脊液基因组测序检测到了血链球菌。该病例报告表明,通过脑脊液基因组测序可以诊断出临床原因不明的脑膜脑炎。[国际神经病学神经外科学杂志, 2021, 48(2):202-206]     

对鉴别细菌性和病毒性脑膜脑炎五种实验检查的评价

中枢神经系统感染的致死率高达8-13%.根据感染症状以及脑膜刺激征或颅内高压或神经损害体征等临床上可疑诊为脑膜脑炎,而病原学诊断则依赖于脑脊液(CSF)病原微生物的鉴定.CSF细胞化学变化的研究对大多数病人做出了诊断;然而在4-13%的细菌性脑膜脑炎的病例中其CSF的变化无特异性,与无菌性脑膜脑炎难以区别.病因学诊断依赖于CSF病原菌的分离,这种方法对细菌性脑膜脑炎需48-72小时,而对病毒性脑膜脑炎则需2周.这种方法有20-40%的细菌性脑     

脑脊液MMP-9 IGF-Ⅱ水平检测在颅内感染鉴别诊断中的意义

目的探讨血清和脑脊液中基质金属蛋白酶9(MMP-9)、胰岛素样生长因子-2(IGF-Ⅱ)在化脓性脑膜脑炎和病毒性脑炎鉴别诊断中的应用价值。方法选取入院24h内92例明确诊断中枢神经系统感染患者,其中化脓性脑膜脑炎(化脑组)18例,病毒性脑炎(病脑组)74例和20例非中枢神经系统感染者(对照组)的脑脊液,应用酶联免疫吸附(ELISA)法测定血清及脑脊液(CSF)中MMP-9及IGF-Ⅱ浓度。结果血清及CSF中MMP-9含量比较:化脓性脑膜脑炎和病毒性脑炎组均较对照组显著升高(P0.05),化脓性脑膜脑炎组明显高于病毒性脑炎组(P0.05)。血清及CSF中IGF2Ⅱ含量比较,化脓性脑膜脑炎组CSF中IGF2Ⅱ含量高于病毒性脑炎组及对照组(P0.01),血清IGF2Ⅱ含量化脓性脑膜脑炎组低于病毒性脑炎组及对照组(P0.01),病毒性脑炎组与对照组比较差异无显著性。结论联合测定血清及脑脊液MMP-9及IGF-Ⅱ含量的变化,有助于颅内感染早期鉴别诊断。     

下期内容预告

本刊2013年第1和第2期报道专题为中枢神经系统感染专辑,重点内容包括:结核性脑膜炎临床诊断思路;神经变性疾病脑脊液中有价值的生物学标志;新型边缘性脑炎及临床思考;玻片离心沉淀法脑脊液细胞学检查在中枢神经系统感染性疾病诊断中的应用价值;隐球菌性脑膜炎的早期诊断与规范化治疗;改良抗酸染色法检测脑脊液细胞内外结核杆菌;抗NDTSPOT.TB     

广州管圆线虫致幼儿嗜酸粒细胞性脑膜脑炎(附2例报告及文献复习)

目的提高临床医生对广州管圆线虫致幼儿嗜酸粒细胞性脑膜脑炎的认识及诊疗水平。方法回顾性分析2例广州管圆线虫致幼儿嗜酸粒细胞性脑膜脑炎患儿的临床资料、影像学和基因检测等结果,结合文献探讨其临床特点、诊断方法及治疗措施。结果 2例患儿年龄分别为1岁10个月和1岁3个月、无明确接触史,主要临床症状表现为发热、精神疲倦,2例在外院均误诊治疗。外周血嗜酸粒细胞增高,脑脊液细胞数增高、嗜酸粒细胞 10%;高通量基因检测到广州管圆线虫。阿苯达唑联合小剂量泼尼松治疗后病情恢复。结论幼儿广州管圆线虫嗜酸粒细胞性脑膜脑炎容易误诊、病死率高,早期完善头颅影像、脑脊液检查和分子基因测序可明确广州管圆线虫嗜酸粒细胞性脑膜脑炎的诊断。阿苯达唑辅以小剂量泼尼松治疗效果良好。     

采用脑脊液宏基因组二代测序联合拷贝数变异分析技术辅助诊断脑膜癌病

目的初步探索通过脑脊液宏基因组二代测序(mNGS)联合染色体拷贝数变异(CNV)分析技术对脑膜癌病辅助诊断的意义。方法连续入组北京协和医院神经科2022年3月至2022年6月确诊的10例脑膜癌病患者。脑膜癌病的诊断依据中华医学会神经病学分会感染性疾病与脑脊液细胞学学组《脑膜癌病诊断专家共识》的标准, 经脑脊液细胞学确诊。采用脑脊液mNGS病原微生物与CNV双组学检测。对照组为中枢神经系统炎性疾病患者, 包括自身免疫性脑炎与病毒性脑炎, 共10例。结果入组的10例脑膜癌病患者中, 肿瘤来源包括乳腺癌4例、肺癌6例。脑脊液mNGS联合CNV检测结果8例阳性, 检测到非整倍体CNV, 支持脑膜癌病的诊断;阳性率为8/10, 阳性患者的肿瘤来源包括肺癌4例、乳腺癌4例。脑脊液CNV阴性患者2例, 均为肺癌。全部患者脑脊液mNGS病原微生物分析结果均阴性;对照组CNV分析结果无阳性病例。结论脑脊液CNV可作为脑膜癌病的诊断标志物, mNGS联合CNV对诊断脑膜癌病具有较高的阳性率, 病原微生物与CNV的双组学联合分析的检测策略有助于拓宽脑脊液mNGS在临床辅助诊断的应用范围。     

影响脑脊液细胞玻片离心沉淀检查法质量的原因分析及其预防策略

脑脊液细胞玻片离心沉淀检查法对多种中枢神经系统疾病的定性诊断具有极其重要的价值,特别是对中枢神经系统感染、白血病和脑膜癌病等的诊断更具其他检查方法无法替代的作用。脑脊液细胞收集和染色技术对脑脊液细胞学检查的质量至关重要,然而实践中,特别是临床经验尚缺的新手常存在影响其质量的多种主观和客观原因。本文主要对影响脑脊液细胞玻片离心沉淀检查法质量的常见原因和预防策略进行简要介绍,供神经科同道参考。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.