3种不同性质脑膜炎患者脑脊液细胞学及特殊染色的动态观察

Dynamic observation of cerebrospinal fluid cytology and specific stain in tuberculous meningitis, purulent meningitis and cryptococcal meningitis

目的探讨脑脊液细胞学及特殊染色方法诊断结核性脑膜炎（结脑）、化脓性脑膜炎（化脑）和隐球菌性脑膜炎（隐脑）的临床价值。方法对三种疾病共179例患者脑脊液细胞学资料进行回顾性分析。所有病例均进行脑脊液细胞学MGG染色、阿立新兰染色和墨汁染色的动态观察，70例结脑同时应用免疫荧光和免疫细胞化学方法进行结核抗原的检测。结果①结脑特征性的细胞学表现为混合细胞反应。早期嗜中性粒细胞比例可达80％以上，随治疗逐渐下降，1—2个月后以淋巴样细胞反应为主。免疫荧光法和免疫细胞化学法检测脑脊液单核细胞内结核抗原，敏感性分别为82．9％和85．7％。②化脑急性期脑脊液中以嗜中性粒细胞为主，抗生素治疗后迅速下降。③MGG染色、阿立新兰染色和涂片墨汁染色诊断隐脑的阳性率分别为83．3％、81．8％和76，5％。结论脑脊液细胞学的动态观察联合应用特殊染色方法，可大大提高颅内感染性疾病的诊断和鉴别诊断，并对治疗及预后判断有指导意义。

Objective To study the clinical value of cerebrospinal fluid cytology （ csfc ） and specific stain in tuberculous meningitis （TBM） ,purulent meningitis（PM） and cryptococcal meningitis（CM）. Methods The csfc data of 179 patients with TBM,PM and CM were retrospectively analyzed. The samples collected from all of these patients were analyzed by csfc May-Grunwald-Giemsa （MGG） staining, aricine blue staining and Indian ink staining. And the cytospin smears from 70 TBM were simultaneously stained by the immunofluorescence （ IF ） and immunocytological method to demonstrate the presence of mycobacterial antigen. Results ①TBM group showed a mixed-cell response. At the early stage of disease, the proportion of neutrophilic granulocyte reached 80%, and then reduced gradually. Lyumphoidocyte reaction was the most obvious in 1 - 2 months. The immunofluorescence （ IF ） and immunocytological method present a sensitivity of 82.9% and 85.7% , respectively. ②Neutrophilic granulocyte was the most cell at acute stage of PM, and it descended quickly once treated with effective antibiotics. ③The positive rates to detect C M with csfc M GG, aricine and Indian ink staining were 83.3 %, 81.8 %, and 76.5 %, respectively. Conclusion Dynamic observation on cerebrospinal fluid cytology is helpful do boost the differential diagnosis of intracranial infection.