脑脊液免疫球蛋白及白蛋白对脑膜炎的鉴别诊断意义

目的　分析脑脊液 (CSF)免疫球蛋白 (Ig)和白蛋白 (Alb)对病毒性脑膜炎 (VM )、结核性脑膜炎 (TM )、化脓性脑膜炎(PM )的鉴别诊断意义。方法　用速率散射比浊法测定VM 5 3例 ,TM 40例 ,PM 14例患者CSFIg和Alb的含量。结果　IgG、IgM和Alb在TM和PM中均显著高于VM组 (P <0 0 0 1) ,且以PM升高最明显 ,但TM和PM间 ,Alb及比值变化无显著性意义 ;与VM相比 ,TM以IgG变化最突出 ( 75 %) ,PM以IgM变化为显著 ( 78%) ;Alb在TM和PM升高比例最高 ( 10 0 %)。PM 14例中有 12例 ( 85 .7%)、TM 40例中仅 6例 ( 15 %)符合典型CSF常规和生化改变。如果把CSFAlb >3 0 0mg/L和IgG >61mg/L作为条件 ,则TM的诊断阳性率达 3 8/ 40 ( 95 %)。结论　TM和PM血脑屏障的破坏明显大于VM ,CSFIg和Alb的含量检测弥补了CSF常规分析的不足 ,有助于颅内感染的诊断和鉴别诊断

The Significance of Immunoglobulins and Albumin in the Cerebrospinal-fluid (CSF) on Differential Diagnosis of Meningitis

Objective To explore the effect of immunoglobulins(Ig) and albumin(Alb) in the cerebrospinal-fluid (CSF) on differential diagnosis of viral meningitis (VM), tuberculous meningitis (TM) and purulent meningitis (PM). Methods The contents of CSF-Ig and Alb in patients with VM (53 cases),TM (40 cases), or PM (14 cases) were measured by rate scatter nephelometry. Results The contents of IgG, IgM and Alb in TM or PM were significantly higher than those in VM (P<0 001). However, the changes of CSF-Alb content and cAlb/sAlb ratio between TM and PM were not significant (P>0 05). Compared with VM, the most remarkable change of CSF-Ig in TM was IgG (75%), and IgM (78%) in PM. The rising ratio of CSF-Alb in TM and PM was 100%. The changes of CSF routine and biochemistry in 12 cases of PM (85 7%) and 6 cases of TM (15%) were typical. The positive rate of diagnosis on TM reached 38/40(95%)when CSF-Alb>300mg/L and IgG>61mg/L. Conclusion The destruction of blood-brain barrier in TM and PM was obviously stronger than that in VM. The contents of CSF-Ig and -Alb are helpful to diagnose and differntially diagnose meningitis.