脑脊液细胞学检查和病毒抗体检测对病毒性脑膜脑炎的诊断价值

The Diagnostic Value of Combination of Cerebrospinal Fluid Cytological Analysis with Viral Antibodies Detecting in Viral Encephalitis

目的:探讨脑脊液细胞学检测和病毒抗体检测对病毒性脑膜脑炎的诊断价值。方法:选择84例颅内感染患者分为:病毒性脑膜脑炎组32例,结核性脑膜脑炎组32例,化脓性脑膜脑炎组20例。结核性脑膜脑炎组和化脓性脑膜脑炎组作为对照。每例患者各取2次脑脊液,共168份脑脊液。分别行细胞学检测和ELISA法检测病毒系列抗体IgG、IgM。结果:病毒性脑膜脑炎的脑脊液细胞学超早期有明显的嗜中性粒细胞反应,随后出现激活的淋巴细胞反应;随着患者病情好转,激活的淋巴细胞逐渐减少;转而以淋巴细胞、单核细胞为主。病毒抗体IgG检测:病毒性脑膜脑炎组阳性率为86.7%,明显高于结核性脑膜脑炎组(48.3%)和化脓性脑膜脑炎组(15%);抗体IgM检测:病毒性脑膜脑炎组与结核性脑膜脑炎组和化脓性脑膜脑炎组比差异无统计学意义。结论:脑脊液细胞学检查快速、简便,是中枢神经系统病毒感染的重要指标之一;病毒特异性IgG抗体诊断病毒性脑膜脑炎的敏感度为54.7%,特异度为91.3%,是确诊病毒性脑膜脑炎病原的方法之一。

Aim：To investigate the diagnostic value of combination of with cerebrospinal fluid cytological analysis with viral antibodies detecting in viral encephalitis.Methods：168 cerebrospinal fluid samples from 84 patients who were diagnosed as intracranial infection were detected to find IgG and IgM antibodies by using cytological detection and ELISA.Results：It showed the obvious neutrophilic granulocyte reaction in the super-acute stage.Subsequently the activated lymphocyte reaction appeared.Along with the condition improved the activated lymphocyte disappeared gradually instead of the occurrence of lymphocytes and monocytes.The results of detecting viral antibodies showed the positive rate of IgG in viral encephalitis group was much higher than that in the control group（48.3%,15%）,while the rate of IgM had no conspicuous difference between the groups.Conclusion：The cytological analysis of cerebrospinal fluid plays an important role in the diagnosis of the viral encephalitis because of its convenience and fastness.The sensitivity of IgG by ELISA was 54.7% and the specificity was 91.3%,ELISA is one of the exact etiologic method to diagnose the viral encephalitis.