结核性脑膜炎脑脊液细胞学的临床研究

The clinical research of cerebrospinal fluid cytology in tuberculous meningitis

目的探讨脑脊液(cerebrospinal fluid,CSF)细胞学对结核性脑膜炎的诊断及预后评估价值。方法对766例结核性脑膜炎、103例化脓性脑膜炎、107例病毒性脑膜炎患者脑脊液分别应用细胞玻片离心沉淀器收集CSF细胞、采用迈-格-姬(May-Gruwald-Giemsa,MGG)染色法、光学显微镜分类计数,对CSF细胞进行动态观察。结果 766例结核性脑膜炎患者中700例CSF细胞学显示为混合细胞型,占91.38%(700/766),66例显示为淋巴样细胞型,占8.62%(66/766)。103例化脓性脑膜炎患者以中性粒细胞型为主,107例病毒性脑膜炎患者以淋巴细胞型为主。大淋巴样细胞在结核性脑膜炎中的出现率为97.52%(747/766),而化脓性脑膜炎及病毒性脑膜炎则偶见,分别为9.71%(10/103)和14.02%(15/107);结核性脑膜炎随着病情好转,中性粒细胞、大淋巴样细胞逐渐减少。化脓性脑膜炎随着抗炎治疗,中性粒细胞逐渐减少直至消失;病毒性脑膜炎中性粒细胞一般在24h内消失。结论 CSF细胞学的类型及动态变化可以作为鉴别3种脑膜炎的依据之一,并对结核性脑膜炎患者的预后评估有参考作用。

Objective To study the diagnostic and prognostic value of cerebrospinal fluid（CSF） cytology in tuberculous meningitis.Methods CSF cells were collected with FMU-5 were evaluated with optical microscope after May-Grunwald-Giemsa（MGG） staining.Results In 91.38%（700/766） of patients with tuberculous meningitis,CSF cytology demonstrated a mixed cell profile,and in 8.62%（66/766） a lymphoid cell profile was shown,whereas neutrophils in purulent meningitis and lymphocytes in viral meningitis predominated.Large lymphoid cells were seen in 97.52%（747/766） of tuberculous meningitis,but rarely seen in purulent meningitis or viral meningitis.The number of neutrophils and large lymphoid cells gradually decreased with the improvement of tuberculous meningitis;persisted existence of neutrophils and large lymphoid cells predicted a poor prognosis.Conclusion CSF cytology of tuberculous meningitis is a mixed cell and lymphoid cell profile.Large lymphoid cells are characteristic features of tuberculous meningitis;dynamic changes in CSF cytology can be used for differentiating different types of meningitis and for evaluating the prognosis.