结核性脑膜炎和非结核性脑膜炎的鉴别诊断分析

Analysis on differential diagnosis of tuberculous meningitis and non-tuberculous meningitis

目的评价临床特征、实验室及影像学检查在结核性脑膜炎(tuberculous meningitis,TBM)和非结核性脑膜炎[病毒性脑膜炎(viral meningitis,VM)和隐球菌性脑膜炎(cryptococcal neoformans meningitis,CNM)]早期诊断中的价值。方法回顾性分析283例TBM、31例VM和19例CNM患者的临床特征、实验室及影像学检查结果。结果发病至确诊时间CNM>TBM>VM,体温>38.5℃、头痛及意识障碍发生率TBM组高于VM,脑脊液(cerebrospinal fluid,CSF)腺苷脱氨酶(ADA)TBM[(12.13±28.52)U/L]与VM及CNM[(4.48±2.84)U/L、(3.09±1.63)U/L]比较,差异有统计学意义(P﹤0.05)。CSF糖CNM为(1.57±0.99)mmol/L,与TBM及VM[(1.84±0.93)mmol/L、(2.42±0.75)mmol/L]比较,差异有统计学意义(P﹤0.05)。CSF氯TBM为(110.14±8.64)mmol/L,与VM[(116.54±7.33)mmol/L]比较,差异有统计学意义(P﹤0.05)。CSF蛋白TBM为(1811.70±1285.70)mg/L,与CNM[(1158.60±875.50)mg/L]比较,差异有统计学意义(P﹤0.05),治疗1周后TBM与VM比较[(1416.90±1017.40)mg/Lvs.(734.30±556.50)mg/L],差异有统计学意义(P﹤0.05)。颅压CNM[(305.00±53.17)mmH2O]与TBM[(241.23±80.32)mmH2O]及VM[(220.80±71.77)mmH2O]比较,差异有统计学意义(P﹤0.05)。结论年龄、病程、体温、头痛、意识障碍,血及CSF的ADA,CSF糖、氯、蛋白,颅压及影像学检查对TBM和非结核性脑膜炎的鉴别诊断有意义。

Objective To evaluate clinical features, laboratory and imageologic examination on early differential diagnosis of tuberculous meningitis（TBM）, viral meningitis （VM） and cryptococcal neoformans meningitis （CNM）. Methods Results of clinical features, laboratory and imageologic examination were retrospectively analyzed in 283 patients with TBM, 31 patients with VM and 19 patients with CNM. Results The duration from onset to definite diagnosis was CNM〉 TBM 〉VM. Fever （〉38.5℃）, headache and disturbance of consciousness of TBM were more serious than that of VM. CSF-ADA of TBM [（12.13±28.52） U/L] was significantly higher than that of VM [（4.48±2.84） U/L] and CNM [（3.09±1.63） U/L]. CSF-GLU of CNM [（1.57±0.99） mmol/L] was significantly lower than TBM [（1.84±0.93） mmol/L] and VM [（2.42± 0.75） mmol/L]. CSF-CL of TBM [（110.14 ±8.64）mmol/L] was significantly lower than VM [（116.54 ±7.33）mmol/L]. CSF-PRO of TBM[（1811.70±1285.70）mg/L] was significantly higher than CNM[（1158.60±875.50）mg/L]. CSF-PRO of TBM was significantly higher than VM after 1 week treatment. CSF pressure of CNM [（305.00±53.17）mmH2O] was significantly higher than TBM [（241.23±80.32）mmH2O] and VM [（220.80±71.77）mmH2O]. Conclusions Early differential diagnosis of tuberculous meningitis and non-tuberculous meningitis should be based on age, the duration from onset to diagnosis, temperature, headache, decreased level of consciousness, blood and CSF-ADA, CSF-GLU, CSF-CL, CSF-PRO, CSF pressure and imageologic examination.