结核性脑膜炎临床诊断的分析

An analysis of clinical diagnoses of tuberculous meningitis

目的:探讨结核性脑膜炎(TBM)的临床诊断.方法:对45例TBM和40例病毒性脑炎(病脑)患者的临床症状及辅助检查资料进行回顾性分析.结果:颅神经损害在TBM组发生率较高(P<0.05),发热、头痛、呕吐、精神异常、意识障碍、脑膜刺激征及颅内压等两组间无差别.TBM组结核菌素试验阳性率显著高于病脑组(P<0.05),而血沉无明显差异.TBM组EEG、头颅CT及MRI表现异常亦均高于病脑组(P<0.05).TBM组脑脊液的蛋白、免疫球蛋白IgG和IgM高于病脑组(P<0.05),而氯化物低于病脑组,葡萄糖及免疫球蛋白IgA两组之间无差别.TBM组脑脊液的中性粒细胞百分率、混合型细胞反应均高于病脑组,而淋巴样细胞反应低于病脑组(P<0.05).结论:综合分析患者的临床表现和实验室尤其是脑脊液细胞学检查结果,对TBM的诊断能起到非常重要的作用.

AIM：To analyze the clinical diagnoses of tuberculous meningitis. METHODS：Clinical symptoms and auxiliary examinations of 45 patients with tuberculous meningitis and 40 patients with virus meningitis were analyzed retrospectively. RESULTS：The cranial nervous lesions were more common in patients with tuberculous meningitis than patients with virus meningitis （P〈0.05）but no significant differences was seen in fever,headache,vomiting,emotional disturbance,conscious disturbance,meningeal irritation sign and intracranial pressure between the two groups. The positive rate of tuberculin test of tuberculous meningitis was higher than that of virus meningitis （P〈0.05） but no apparent difference was observed in blood sedimentation rate. The abnormality of the electroencephalogram,cranial computed tomography and magnetic resonance imaging of tuberculous meningitis was higher than that of virus meningitis （P〈0.05）. The protein,immunoglobulin G and immunoglobulin M of cerebrospinal fluid of tuberculous meningitis were higher than those of virus meningitis （P〈0.05）. The chloridum of tuberculous meningitis was lower than that of virus meningitis,but with no difference in glucose and immunoglobulin A between the two groups. The percentage of neutrophilic leukocytes and intermix cytology reaction of the tuberculous meningitis were higher than those of virus meningitis（P〈0.05）,whereas lymphoid cytology reaction was lower. CONCLUSION：The aggregate analysis of clinical manifestations and auxiliary examinations,especially of cerebrospinal fluid cytology,play very important roles in the clinical diagnosis of tuberculous meningitis.