颅内感染患者脑脊液检查结果分析

Analysis of cerebrospinal fluid in patients with intracranial infections

目的探讨5种不同颅内感染性疾病的脑脊液(CSF)特点,以提高对颅内感染性疾病诊断水平。方法选择234例颅内感染患者的CSF检查结果共484份,进行回顾性分析。结果病毒性脑膜炎、脑炎和脑脓肿CSF改变较轻,病毒性脑膜炎、脑炎44次病原学检查结果均阴性;化脓性脑膜炎CSF表现为白细胞和蛋白显著升高,糖和氯化物降低,经治疗后,迅速好转;急性及亚急性起病的结核性脑膜炎CSF改变与化脓性脑膜炎有许多相似之处,但白细胞数及蛋白升高二者具有统计学意义,且持续时间较长,对治疗反应也不同。结论不同颅内感染性疾病不同时期的CSF检查结果对颅内感染的诊断及预后判断有重要的参考价值,病原学检查是颅内感染的确诊依据,但因阳性率低,故临床诊断不能过分依赖其结果。

Objective To investigate the characteristics of cerebrospinal fluid （CSF） of 5 kinds of intracranial infectious diseases in order to improve the diagnosis. Methods Records of 484 cerebrospinal fluid from 234 （ male, female） hospitalized patients of intracranial infectious diseases were reviewed. Results The change of CSF of viral meningitis, viral encephalitis and brain abscess was lighter, and 44 cases of the detection of pathogen were all negative. The CSF of purulent meningitis reveals the prominent growth of WBC count and protein content as well as the decrease of glucose and chloride. After the treatment, the patients appeared well in a short time. There were many similarities of the change about CSF between the acute and sub - acute tubereulous meningitis and purulent meningitis. But it appeared sharp difference between the growth of WBC count and protein content. It lasted for long time and leads to different treatment reactions. Conclusion It is important to detect CSF at different stage in different cerebral disease for diagnosis and judgement of prognosis of intracranial infections. The detection of pathogen is the gold standard of diagnosing intracranial infections. But it is not practical to rely on pathogen detection in clinical work because of its low positive rate.