结核性脑膜炎抗结核菌纯蛋白衍生物抗体与脑脊液细胞学的相关性

目的 探讨结核性脑膜炎(结脑)患者不同阶段抗结核菌纯蛋白衍生物(PPD)抗体阳性率及脑脊液细胞学变化，推测二者之间是否有相关性及其诊断价值。方法 结脑患者26例，病毒性脑膜炎（病脑）患者30例，在发病1、2、3、4周分别测其脑脊液抗PPD抗体IgG及脑脊液细胞学结果。结果 结脑组在发病早期1周内，抗PPD抗体IgG阳性率低，脑脊液细胞学浆细胞出现率低；发病2~3周，抗PPD抗体IgG阳性率升高，浆细胞出现比例升高；发病4周，经有效治疗后，抗PPD抗体IgG阳性率仍高，浆细胞比例降低或消失。病脑组在发病第1、2、3、4周脑脊液抗PPD抗体IgG阴性，脑脊液细胞学以淋巴细胞反应为主，浆细胞出现率低。结论 结脑患者抗PPD抗体IgG阳性率低，浆细胞比例低或无；抗PPD抗体IgG阳性率高，浆细胞比例高，二者有相关性；二者结合可提高早期结脑诊断率。

Clinical study on correlation between anti PPD antibody and cerebrospinal fluid cytology in patients with tuberculous meningitis

Objective To investigate the cytological changes of cerebrospinal fluid in tuberculous meningitis patients with different positive rates of anti purified protein derivative of tuberculin (PPD) antibody, and further to evaluate their correlation and diagnostic value. Methods The anti PPD antibody IgG and cytology of cerebrospinal fluid in 26 tuberculous meningitis patients and 30 cases of viral meningitis in the control group were detected at the 1st, 2nd, 3rd and 4th week of onset. Results At the early stage of onset, tuberculous meningitis patients of the positive rate of anti PPD antibody IgG and the plasmacyte ratio of cerebrospinal fluid cytology were low within the 1st week, while these rates increased during the 2nd to 3rd week. After effective treatment, although the positive rate of anti PPD antibody IgG was still high, the plasmacyte ratio decreased and even disappeared. Cerebrospinal fluid (CSF) anti PPD antibody IgG was negative at the 1st ,2nd, 3rd and 4th week of onset in CSF group. Lymphocyte reactivity was dominant in CSF cytology, and the rate of plasma cell was low. Conclusion There is better correlation between anti PPD antibody IgG and plasmacyte ratio in cerebrospinal fluid, which represents as low positive rate of anti PPD antibody IgG accompanies with low or no plasmacyte ratio, while high positive rate of anti PPD antibody IgG accompanies with high plasmacyte ratio, the combination of both examinations could improve the early diagnosis rate of tuberculous meningitis.