结核性和病毒性脑膜炎鉴别诊断的回顾性研究

目的 研究结核性和病毒性脑膜炎多项实验室指标在鉴别诊断中的量化标准和敏感性，探讨患者入院后脑脊液蛋白含量显著增高的影响因素。方法 对29例结核性和31例病毒性脑膜炎患者进行回顾性对比研究，比较其临床症状、外周血和脑脊液的实验室检测结果，采用Logistic回归分析脑脊液蛋白含量显著增高的影响因素。结果 结核性脑膜炎从临床症状、血常规、血糖、脑脊液白细胞及分类上很难与病毒性脑膜炎相鉴别。与病毒性脑膜炎相比，当脑脊液的糖含量＜2.5mmol/L、脑脊液蛋白含量＞1.0g/L、脑脊液氯化物含量＜120.0mmol/L、脑脊液糖与血糖比值＜0.50时应高度疑诊为结核性脑膜炎。上述指标鉴别结核性脑膜炎的敏感性为：脑脊液糖与血糖比值＜0.50，高于脑脊液的糖含量＜2.5mmol/L；脑脊液蛋白含量＞1.0g/L，高于脑脊液氯化物含量＜120.0mmol/L。脑脊液蛋白含量＞1.0g／L与脑脊液氯化物含量＜122．8mmol/L呈负相关。结论 上述指标的量化标准有助于提高结核性与病毒性脑膜炎鉴别诊断的敏感性和准确性。     

结核性脑膜炎脑脊液免疫学诊断

结核性脑膜炎（tuberculous meningitis,TBM）是一种病死率和致残率很高的中枢神经系统感染性疾病,临床表现缺乏特异性,病情变化迅速,早期诊断困难。近年来,TBM的脑脊液（CSF）免疫学诊断以其极高的敏感性和特异性得到迅速发展,临床应用前景广阔。现就TBM的CSF免疫学诊断做一综述。     

结核性与化脓性脑膜炎的脑脊液生化指标鉴别诊断

目的研究脑脊液生化指标在结核性脑膜炎和化脓性脑膜炎鉴别诊断中的应用价值。方法选择我院收治的102例结核性脑膜炎患者(结脑组)及89例化脓性脑膜炎患者(化脑组)为研究对象。对全部患者血浆及脑脊液中的蛋白、糖、氯化物和腺苷脱氨酶(ADA)进行检测。同时,对脑脊液与血浆中的蛋白、糖、氯化物和ADA比值进行计算并比较。结果结脑组脑脊液检测中,氯化物水平显著低于化脑组(P0.01),ADA水平显著高于化脑组(P0.01);结脑组血浆检测中,蛋白及氯化物水平显著低于化脑组(P0.01),ADA水平显著高于化脑组(P0.01);结脑组脑脊液与血浆生化指标比值中,蛋白及ADA的比值显著高于化脑组(P0.05),氯化物的比值显著低于化脑组(P0.01)。结论脑脊液中氯化物和ADA水平及脑脊液和血浆中蛋白、ADA及氯化物的比值对结核性脑膜炎和化脓性脑膜炎的早期鉴别诊断具有一定的价值。     

脑脊液中检测DLL1对结核性脑膜炎的诊断意义

目的探索脑脊液(CSF)中Delta-like-1(DLL1)的检测在结核性脑膜炎诊断中的临床价值。方法选择诊断明确的中枢神经系统感染性疾病患者50例,分为结核性脑膜炎(结脑组)30例,病毒性脑(膜)炎(病脑组)20例,以及正常对照组20例,颅内转移瘤(肿瘤组)8例。采用酶联免疫吸附试验定量测定患者CSF中DLL1的含量。结果各组CSF中DLL1的含量,结脑组显著高于其他组别,差异均有统计学意义(P<0.01),其他组别之间相比差异均无统计学意义(P>0.05)。各组CSF中DLL1的含量与CSF蛋白、细胞数、葡萄糖、氯化物及颅内压均无相关性。结论 DLL1检测作为一种新的指标,在结核性脑膜炎的诊断中可能有重要临床价值。     

急性细菌性脑膜炎和病毒性脑膜炎的鉴别诊断

目的　研究多项实验室检测指标在急性细菌性和病毒性脑膜炎鉴别诊断中的敏感性及量化标准 ,并探讨其临床应用价值。方法　对 2 6例急性细菌性和 31例病毒性脑膜炎患者进行回顾性研究 ,分别比较其临床症状、外周血像 ,血糖和脑脊液白细胞数、蛋白、糖的检测结果。结果　从临床症状和外周血像上很难鉴别急性细菌性和病毒性脑膜炎 ,但当脑脊液的糖 <1.7mm ol/ L、脑脊液白细胞总数 >2 0 0 0× 10 6/ L、中性粒细胞数 >10 0 0× 10 6/ L、蛋白 >2 .0 g/ L、脑脊液糖与血糖比值 <0 .35时应高度怀疑细菌性脑膜炎。上述指标鉴别两者的敏感性依序为 :脑脊液糖与血糖比值、脑脊液糖、蛋白和脑脊液中性粒细胞数、脑脊液白细胞总数。结论　上述量化标准有助于提高细菌性与病毒性脑膜炎鉴别诊断的敏感性和准确性 ,降低误诊率     

结核性脑膜炎和病毒性脑炎患者的血脑屏障破坏与脑脊液蛋白质指数变化

目的：分析结核性脑膜炎和病毒性脑炎患者血脑屏障破坏与脑脊液白蛋白指数变化的关系及中枢神经系统免疫状况,为临床治疗提供指导。方法结核组31例,27例病毒性脑炎患者为病毒组,同时选取性别、年龄无显著性差异、排除中枢神经系统感染的患者22例为对照组,采用免疫比浊法检测3组患者血清和脑脊液白蛋白及Ig A、Ig M、Ig G等免疫球蛋白水平,观察3组指标的变化情况。结果结核组脑脊液白蛋白水平及脑脊液白蛋白指数高于对照组（P＜0.05）。结核组和病毒组血脑屏障损伤程度均高于对照组（P＜0.05）,结核组IgA、IgG、IgM指数均高于对照组（P＜0.05）。结论结核性脑膜炎患者血脑屏障损害较病毒性脑炎患者严重,且中枢免疫反应强于病毒性脑炎患者。     

结核性脑膜炎治疗前后脑脊液动态变化的研究

目的探讨结核性脑膜炎（TBM）治疗前后脑脊液（CSF）的变化及其对临床诊断的意义。方法回顾性分析2009-2011年南京脑科医院确诊的42例TBM患者治疗前、治疗后1周及治疗后2周CSF各指标的动态变化。结果与治疗前比较,治疗后第二周CSF各指标大部分有显著变化（P〈0.05）。治疗后第2周CSF各指标较治疗后第1周虽有变化,但大部分无明显差异,仅中性粒细胞百分比、免疫白蛋白及免疫球蛋白两项指标差异明显（P〈0.05）。结论TBM治疗前后CSF各指标变化明显,对于诊断有重要参考意义。     

结核性脑膜炎358例脑脊液分析

目的探讨结核性脑膜炎(TM)患者的脑脊液(CSF)变化特点及诊断价值。方法收集河南省传染病医院2005-06—2012-06收治的358例TM患者的临床资料,同时包括CSF检查结果,对CSF的变化特点进行分析和评估。结果 358例TM患者中,颅内压升高226例,蛋白升高308例,核细胞数升高40例,葡萄糖含量降低297例,氯化物降低283例。结论 CSF检测有助于TM的确诊及预后判断。     

脑脊液腺苷脱氨酶检测对结核性脑膜炎诊断的价值

目的探讨脑脊液腺苷脱氨酶（ADA）检测对结核性脑膜炎诊断的价值。方法对27例结核性脑膜炎患者及68例非结核性脑膜炎患者进行脑脊液ADA活性检测及分析。结果结核性脑膜炎组ADA活性范围明显高于非结核性脑膜炎组,差异有统计学意义（P〈0．01）。结论脑脊液腺苷脱氨酶活性升高可作为结核性脑膜炎诊断的一个重要辅助指标。     

脑脊液单核细胞内ESAT-6对结核性脑膜炎的诊断价值

目的通过检测结核性脑膜炎(tuberculous meningitis,TBM)患者脑脊液单核细胞中的早期分泌抗原靶蛋白6(early secreted antigenic target,ESAT-6),探讨ESAT-6在TBM诊断中的价值。方法将42例TBM患者与47例对照组患者进行脑脊液生化、细胞学、抗酸染色检查,同时用免疫荧光细胞化学染色法检测脑脊液单核细胞内的ESAT-6。结果在临床诊断TBM的42例患者中有38例脑脊液单核细胞中检出ESAT-6,47例对照组中检出4例。TBM组ESAT-6的检出率明显高于对照组(P<0.05)。该方法诊断TBM的敏感性为90.48%,特异性为91.49%。约登指数达到0.82。结论检测脑脊液单核细胞内结核特异性抗原ESAT-6用于诊断TBM,具有灵敏度、特异度高的特点,而且简单易行,有望成为诊断TBM的一种新的辅助方法。     

Mollaret脑膜炎的临床和脑脊液特点(附1例报告)

目的探讨Mollaret脑膜炎(MM)的临床与脑脊液(CSF)特点。方法回顾性分析1例MM患者的临床资料。结果本例男,26岁,急性起病,以头痛、发热、恶心、呕吐及脑膜刺激征为主要表现,先后复发4次。每次复发时的症状及体征基本相似,间歇期完全正常。腰穿CSF检查:白细胞81×106/L,以淋巴细胞为主(0.89),蛋白含量0.71 g/L,氯化物116 mmol/L,IgG 79.5 mg/L。经对症治疗3周基本痊愈。结论MM以头痛、发热、恶心、呕吐及脑膜刺激征为主要临床表现,可反复发作,但预后良好。CSF有细胞数和蛋白增高,以淋巴细胞、单核细胞为主,疾病初期可找到特征性Mollaret细胞。     

老年患者结核性脑膜炎脑脊液细胞学及临床特点

目的探讨老年结核性脑膜炎患者脑脊液细胞学(CSF)变化及临床特点。方法42例病人经临床和辅助检查确诊,采用脑脊液细胞玻片离心沉淀法收集细胞,经MGG染色后在显微镜下观察。结果全部病例脑脊液细胞学均有异常,老年患者脑脊液细胞学有明显不同的特点。结论初诊时,脑脊液细胞学以淋巴细胞比例占优势较多,随病程进展出现程度不同的混合细胞反应,治疗有效者嗜中性粒细胞下降及消失较快;一部分患者一直以淋巴细胞占优势,伴有激活淋巴细胞、激活单核细胞,并持续性较长时间。脑脊液细胞学的动态变化,为判断老年结核性脑膜炎的病情转归、疗效有着重要的临床价值。     

儿童结核性脑膜炎脑脊液蛋白质组学初步研究

目的 结核性脑膜炎是致残、致死率较高的儿童时期常见中枢神经系统感染性疾病。本实验拟通过建立正常中国儿童及结核性脑膜炎患儿脑脊液蛋白质双向凝胶电泳图谱,筛选结核性脑膜炎特异性蛋白,为结核性脑膜炎的早期诊断提供线索,同时也为进一步探讨结核性脑膜炎的发病机制提供新思路。方法 收集结核性脑膜炎患儿和同年龄正常儿童脑脊液各4 ml,固相PH梯度二维聚丙烯酰胺凝胶电泳（2-DE）技术分离蛋白质,考马斯亮蓝染色,Imagescanner扫描仪以及LabScan扫描软件对凝胶进行扫描获取图像,利用图像分析软件PDQuest 7.0进行强度校正、点检测、背景消减、均一化和匹配等分析,以正常儿童脑脊液的2-DE凝胶为参考胶,将结核性脑膜炎患儿脑脊液的凝胶与之进行比较分析,寻找两组患儿脑脊液蛋白质谱的差异表达斑点。结果 正常儿童脑脊液分离获得蛋白质斑点546个,结核性脑膜炎患儿脑脊液分离获得蛋白质斑点533个,发现有64个蛋白质点存在质或量的差别,其中有14个蛋白质点仅在正常儿童CSF表达,有27个点仅在结脑患儿CSF中表达,与正常儿童CSF蛋白质点表达量比较发现,结脑患儿CSF有15个蛋白质点表达量有2倍以上上调,8个蛋白质点表达量有2倍以上下调。共选出20个差异蛋白质点进行MALDI-TOF-MS分析,获得了20张肽质量指纹图谱。进入数据库进行搜索后有15个差异蛋白质已经通过MALDI-TOF-MS鉴定。结论 本实验成功建立了正常儿童和结核性脑膜炎患儿脑脊液蛋白质2-DE图谱,通过凝胶图像分析和计算机信息处理,发现了一些与结核性脑膜炎相关的蛋白质差异位点。经质谱分析及生物信息学技术初步鉴定了部分差异蛋白质,发现载脂蛋白A-I、抗肿瘤坏死因子α抗体、HLA-II 类抗原DRB1-4、MRP14蛋白可能与结核性脑膜炎的发生发展密切相关,这些蛋白能否成为结核性脑膜炎诊断的标记物,值得进一步的研究。     

Brain function estimated from the ratio of glutamine to homocarnosine levels in cerebrospinal fluid

The ratio of glutamine to homocarnosine (G/H ratio) in CSF of children with meningeal pathology or convulsions was measured and the following results were obtained. 1. The mean G/H ratio of normal subjects was 83.0 +/- 41.4. 2. The mean G/H ratios of the patients with bacterial meningitis and meningeal leukemia were 115.9 +/- 81.9 and 115.2 +/- 49.2, respectively. Significant differences were found between those in normal subjects and these diseases. 3. The mean G/H ratio of the patients with viral meningitis was 80.0 +/- 35.1 and no significant difference was found between normal subjects and these patients. 4. The mean G/H ratios in the patients with controlled versus uncontrolled epilepsy were 130.9 +/- 67.1 and 74.8 +/- 49.4, respectively. A significant difference was found between normal subjects and the patients with controlled epilepsy. 5. The mean G/H ratio in the patients with febrile convulsions was 46.5 +/- 6.3. A significant difference was found between normal subjects and these patients. These data suggest that a high G/H ratio in CSF may indicate the excited state of the brain.     

Active and total T cells in blood and cerebrospinal fluid during the course of aseptic meningitis

Patients with aseptic meningitis (AM) were examined with the active T cell rosette test, which has been claimed to reflect cell-mediated immunocompetence more accurately than determination of total T cells. Higher percentages of active T cells were demonstrated in CSF compared to blood regardless if specimens were obtained on days 1–4, days 5–10, or later than 20 days after onset of symptoms. Active T cell percentages in CSF decreased when values for specimens obtained on days 5–10 were compared with those taken later than 20 days after onset, while no significant variations of active T cell percentages in blood were observed. The percentages of total T cells were higher in CSF than blood in specimens from days 5–10, and later than 20 days after onset, but no significant fluctuations of total T cells occurred in either CSF or blood over the course of AM.     

结核性脑膜炎脑脊液细胞学的特征性表现

目的探讨脑脊液细胞学检查对结核性脑膜炎早期临床诊断的价值。方法采用玻片离心沉淀法制片收集脑脊液细胞,瑞-姬姆萨染色(MGG),光学显微镜分类计数。结果37例临床诊断为结核性脑膜炎患者的脑脊液细胞学呈以下改变:细胞学形态以斑片状聚集分布的激活型单核细胞、单核吞细胞和巨噬细胞,周围伴中性粒细胞和淋巴细胞,中性粒细胞比例为35.57±22.95%,类似于无反应性肉芽肿样改变。结论形似无反应性肉芽肿样的脑脊液细胞学改变以及中性粒细胞特征性的比率,可能是结核性脑膜炎早期诊断的特征性改变。     

回顾性分析成人化脓性脑膜炎细菌构成及其脑脊液分布特点

目的回顾性分析宁夏地区成人化脓性脑膜炎(purulent meningitis in adult,APM)患者脑脊液(cerebrospinal Fluid,CSF)细菌构成及特点。方法收集宁夏医科大学总医院2002年01月至2014年07月诊治并行细菌培养的144例化脓性脑膜炎患者临床资料,分析比较致病菌检出阳性与阴性的实验室检查特点,以及不同致病菌(革兰阳性球菌、革兰阴性杆菌及革兰阳性杆菌)患者之间实验室检查特点。结果 144例化脓性脑膜炎的细菌检出阳性率为36.8%(53例),致病细菌以革兰阳性球菌常见[64.15%(34例)],其中以葡萄球菌属为主;细菌检出阳性组患者的血中性粒细胞比例、脑脊液白细胞计数及脑脊液蛋白含量均高于阴性组(分别(82.52±9.43)%,(78.13±13.25)%,P=0.022;(4078.13±5739.24)×10~6/L,(2181.61±4440.87)×10~6/L,P=0.010;(2.99±2.67)g/L,(2.18±2.01)g/L,P=0.041)。发病10d内就诊的101例患者,细菌检出阳性组脑脊液压力、脑脊液白细胞计数、脑脊液中性粒细胞比例亦均高于阴性组((263.82±55.05)mmH_2O,(236.03±66.26)mmH_2O,P=0.032;(4660.45±5756.37)×10~6/L,(2745.97±5193.33)×106/L,P=0.008;(70.21±30.51)%,(56.79±35.54)%,P=0.048),脑脊液淋巴细胞比例较阴性组低((18.92±24.10)%,(32.02±32.10)%,P=0.023)。结论成人化脓性脑膜炎的致病菌以革兰阳性球菌多见,其细菌培养阳性患者的脑脊液与培养阴性者具有一定差异,可能会为临床诊疗提供参考价值。     

Modification of protein transfer across blood/cerebrospinal fluid barrier in response to altered plasma protein composition during development

A developmentally regulated protein-specific transfer mechanism across choroid plexus epithelial cells has previously been proposed to contribute to the characteristically high concentration of protein in cerebrospinal fluid (CSF) in the immature brain. Here we demonstrate that this mechanism is sensitive to protein variations in plasma resulting in changed numbers of transferring cells for individual proteins and altered transfer into the CSF. Pups of Monodelphis domestica at postnatal day (P)9, P65 and P110 were injected intraperitoneally with either adult Monodelphis plasma or exogenous bovine fetuin. Samples of CSF, blood and brain were collected from terminally anaesthetized animals 3-48 h later. The concentration of total protein was measured and levels of albumin, hemopexin, α-fetoprotein and bovine fetuin were estimated by western blotting. Numbers of lateral ventricular choroid plexus cells positive for total and individual plasma proteins were counted in paraffin sections of brains stained with appropriate antibodies. Following intraperitoneal injections, the content of proteins in the CSF increased at all three ages, but the concentration increased only in the CSF of older animals. The total numbers of plexus cells positive for plasma protein did not change significantly, but cells positive for individual proteins did. Fetuin was detected in all protein-positive cells, but apparently displaced α-fetoprotein and, to a lesser degree, hemopexin. The results indicate that protein transfer across the blood/CSF barrier appears to be regulated by a molecular recognition mechanism that is probably saturable but may not be as specific for individual proteins as previously suggested.     

Elevated cerebrospinal fluid and plasma homocysteine levels in ALS

Background:  High cerebrospinal fluid (CSF) and plasma levels of homocysteine (HC) have been reported in certain neurodegenerative disorders, such as Alzheimer's, Parkinson's diseases and, recently, amyotrophic lateral sclerosis (ALS).
Objectives:  To assay the CSF and plasma levels of HC in ALS patients and controls, and to evaluate the relationship between HC levels and clinical variables of the disease.
Methods:  Cerebrospinal fluid from sixty-nine (M/F 1.87) and plasma from sixty-five ALS patients (M/F 1.83) were taken and stored at −80°C until use. Controls (CSF = 55; plasma = 67) were patients admitted to our hospital for neurological disorders with no known relationship to HC changes. CSF and plasma from ALS patients and controls were obtained as a necessary step of the diagnostic workup. HC levels in CSF and plasma were assayed using a high performance liquid chromatograph (HPLC) and a fluorimeter detector.
Results:  The median level of total HC in the CSF of ALS patients was 0.46 μM, significantly higher than that of the controls (0.24 μM, +91.6%, P  < 0.001). A similar trend was observed when HC was assayed in plasma (ALS, 12.4 μM vs. controls, 7.26 μM, +70.8%, P  < 0.001). The CSF and plasma HC levels showed no relationship with the disease progression, age at onset, and the site of onset.
Conclusions:  Homocysteine is a biochemical marker in ALS, and it might be related to the pathophysiology of the disease.