急性病毒性(脑膜)脑炎早期诊断与脑脊液细胞学

Cerebrospinal Fluid Cytology and Early Diagnosis in Patients with Acute Viral Encephalitis or Meningocephalitis

目的探讨脑脊液细胞学(CSFC)检查对急性病毒性(脑膜)脑炎(AVME)的早期诊断价值。方法回顾分析347例AVME患者的CSFC检查结果和相关临床资料。结果347例AVME患者早期症状主要表现为头痛(66.8%)、发热(63.7%)、恶心呕吐(47.0%)、脑膜刺激征(19.9%)、抽搐(13.5%)、精神异常(11.8%)和意识障碍(7.2%)。脑电图检查异常率为74.4%(131/176),脑脊液常规检查异常率为47.6%(165/347),脑MRI检查阳性率为38.1%(8/21),脑CT检查阳性率仅为12.8%(11/86),而CSFC检查阳性率可达90.0%(253/281),其中以淋巴细胞异常为主(88.9%,224/253)。结论AVME早期临床表现多样,在发病早期CSFC检查阳性率较高,对AVME的诊断具重要意义。

Objective To investigate the value of examination of cerebrospinal fluid cytology （CSFC） in early diagnosis of acute viral encephalitis or meningocephalitis. Methods The clinical data and the results of CSFC examination in 347 patients with acute viral encephalitis or meningocephalitis were analyzed retrospectively. Results The major early clinical symptoms were headache （68.8%）, fever （63.7%）, nausea and vomiting （47.0%）, meningeal irritation sign （19.9%）, seizure （ 13.5%）, mental status change （11.8%） and consciousness disorder （7.2%）. EEG, MRI and CT showed abnormality in 74.4% （131/176）, 38.1% （8/21） and 12. 8% （11/86） patients respectively. The abnormal cerebrospinal fluid routine was found in 47.6% patients with increased cell count and/or protein level but normal chloride and glucose levels. The CSFC was abnormal in 90. 0% patients mainly with lymphatic cell changes （88. 9%, 224/253）. Conclusions The clinical manifestation was variable in acute viral encephalitis or meningocephalitis and CSFC was the most important factor in the early diagnosis of acute viral encephalitis or meningocephalitis with the highest abnormality.