急性细菌性脑膜炎和病毒性脑膜炎的鉴别诊断

Differential diagnosis on acute bacterical and viral meningitis

目的 研究多项实验室检测指标在急性细菌性和病毒性脑膜炎鉴别诊断中的敏感性及量化标准 ,并探讨其临床应用价值。方法 对 2 6例急性细菌性和 31例病毒性脑膜炎患者进行回顾性研究 ,分别比较其临床症状、外周血像 ,血糖和脑脊液白细胞数、蛋白、糖的检测结果。结果 从临床症状和外周血像上很难鉴别急性细菌性和病毒性脑膜炎 ,但当脑脊液的糖 <1.7mm ol/ L、脑脊液白细胞总数 >2 0 0 0× 10 6/ L、中性粒细胞数 >10 0 0× 10 6/ L、蛋白 >2 .0 g/ L、脑脊液糖与血糖比值 <0 .35时应高度怀疑细菌性脑膜炎。上述指标鉴别两者的敏感性依序为 :脑脊液糖与血糖比值、脑脊液糖、蛋白和脑脊液中性粒细胞数、脑脊液白细胞总数。结论 上述量化标准有助于提高细菌性与病毒性脑膜炎鉴别诊断的敏感性和准确性 。

Objective To study the quantitive standard and sensitivity of multiple laboratory marker in the differential diagnosis of accute bacterial or viral meningitis,and try to discuss its clinical value.Methods 26 patients with acute bacterial meningitis and 31 patients with viral meningitis were retrospectively analyzed. Clinical symptoms,peripheral blood picture,blood glucose and the leukocyte number of cerebrospianl fluid(CSF),protein,and glucose were compared respectively.Results Acute bacterical meningitis was hardly differentiated from acute viral one by clinical symptoms and peripheral blood picture,but acute bacterical meningitis should be highly suspected in patients with a CSF glucose level <1.7 mmol/L, CSF leukocytes>2000.0×10 6/L,CSF polymorphonuclear leukocytes>1000×10 6/L,protein level>2.0 g/L,the ratio of CSF and blood glucose ratio <0.35,The sensitivity of the subsequence of the laboratory markers were as follows: CSF blood glucose ratio ,CSF glucose level ,CSF protein level and CSF polymorphonuclear leukocytes counts, CSF leukocytes counts.Conclusion The above quantitive standard contributed to increase the diagnostic sensibility,accuracy of acute bacterical and viral meningitis, and decrease the rate of misdiagnosis.