中枢神经系统感染性疾病的脑脊液细胞学分析

[摘要] 目的 评价脑脊液细胞学动态监测在中枢神经系统感染性疾病鉴别诊断及疗效判断中的临床意义。方法 对 117 例中枢神经系统感染性疾病的脑脊液细胞学检测结果进行回顾性分析。结果 117 例患者中,结核性脑膜炎 70 例( 59.83% ),病 毒性 脑膜 炎 30 例( 25.64% ),化 脓性 脑膜 炎 10 例( 8.55% ),隐球 菌性 脑 膜炎 6 例(5.13% ),脑囊虫病 1 例( 0.85% )。结核性脑膜炎的脑脊液细胞学改变主要以混合细胞学反应为主,随着病情的好转,嗜中性粒细胞逐渐减少,但持续时间较长;化脓性脑膜炎主要以嗜中性粒细胞反应为主,抗感染治疗后,嗜中性粒细胞在短时间内迅速减少;病毒性脑膜炎主要以淋巴细胞反应为主;隐球菌性脑膜炎通过脑脊液细胞学检测可直接发现隐球菌,达到病原学诊断;脑囊虫病可见脑脊液中嗜酸性粒细胞增多,杀虫治疗后嗜酸性粒细胞逐渐减少。结论 结核性脑膜炎是最常见的中枢神经系统感染性疾病;通过脑脊液细胞学的动态监测,对中枢神经系统感染性疾病的诊断及判断预后有重要的指导作用。

Cerebrospinal fluid cytology analysis of infectious diseases of the central nervous system

Abstract］ObjectiveTo evaluate the clinical significance of dynamic monitoring of cerebrospinal fluid cytology in the differential diagnosis and therapeutic effect of central nervous system infectious diseases. MethodsThe results of the cerebrospinal fluid cytology in 117 cases of infectious diseases of central nervous system were analyzed retrospectively. ResultsAmong the 117 patients, tuberculous meningitis(TBM) was found in 70 cases（5983%）, viral meningitis(encephalitis) was found in 30 cases(2564%), purulent meningitis(PM) was found in 10 cases(855%), cryptococcal meningitis(CM) was found in 6 cases(513%), andcerebral cysticercosis was found in 1 case(085%). The cases in TBM group showed a mixed cell response in cerebrospinal fluid.With the improvement of the condition, neutrophils was gradually decreased, but the duration was longer. Purulent meningitis was mainly dominated by neutrophils. After anti infection treatment, neutrophils declined sharply in a short period of time. Viral meningitis were mainly in lymphocyte reaction. Cryptococcus neoformans could be directly found in cryptococcal meningitis by cerebrospinal fluid cytology,which can achieve the etiological diagnosis. Eosinophile cells were increased in cerebrospinal fluid in patients with cerebral cysticercosis. Eosinophilia was decreased gradually after insecticide treatment. ConclusionTBM was the most common infectious disease of central nervous system in our hospital. The dynamic monitoring of cerebrospinal fluid cytology had an important role on the diagnosis and guiding the prognosis in patients with infectious diseases of central nervous system.