结核性脑膜炎不同时期多项诊断参数动态比较

Comparion of Several Dignosic Date on the Tuberclous Meningitis Patients at the Different Stage

目的 :探讨提高脑脊液 (CSF)结核杆菌 (MTb)培养阳性的规律 ,对结核性脑膜炎 (TBM )发病不同时期多项检查参数动态观察比较 .方法 :根据不同病程将病人分为 3组 ,A组 (发病 <2周 ) ,B组 (2周～ 1月 ) ,C组 (>1月 ) .对各项检查数据进行动态观察比较 .结果 :A组MTb培养阳性 4例 ,其中侧脑室穿刺 2例MTb培养均呈阳性 ,腰穿 13例只有 2例阳性 ,B组和C组培养阴性 .3组病人CSF蛋白含量持续增高不变 .A组与C组间CSF葡萄糖含量差异有高度显著性 (P <0 0 1) ,B组与C组间差异有显著性 (P <0 0 5 ) ,A组与B组间差异无显著性 (P >0 0 5 ) ,表明发病 2周后CSF葡萄糖含量开始增加 .A组与C组间CSF氯化物含量差异有显著性 (P <0 0 5 ) ,A组与B组间 ,B组与C组间差异无显著性 (P >0 0 5 ) ,表明发病 1月后CSF氯化物含量逐渐增加 .CSF白细胞计数逐渐恢复正常 ,细胞学渐呈慢性炎症特点 ,A组与B组间 ,A组与C组间 ,以及B组与C组间差异有高度显著性 (P <0 0 1) ,表明经过治疗后 ,CSF白细胞数逐渐恢复正常 .头颅影像学改变差异无显著性 .结论 :早期 (2周内 )取CSF有助MTb培养阳性 .CSF蛋白持续增高有助于免疫学诊断 .葡萄糖、氯化物、白细胞计数及细胞学变化可做为判断疾病恢复或迁延的依据 .

MTb) in the cerebrospinal fluid (CSF) and contrasted with several examination results of the tubercular meningitis (TBM) patients at the different stages. Method: According to the different courses of the disease, patients were divided into 3 groups, A group (the course<2 weeks), B group (2～4 weeks) and C group (>4 weeks). Their examination data were compared to each other. Results: There were four positive results of MTB culture in A group, 2/2 in ventricular puncture and 2/13 in lumbar puncture. The culture results in B and C groups were both negative. Along with the developing of the disease, the amounts of the protein components in the CSF kept being high at the three groups. The differences of glucose quantity between A and C groups were high significance (P<0.01), the differences between B and C groups significance too (P<0.05), there were no differences between A and B groups (P>0.05). It means that the quantities of glucose became higher after 2 weeks of the disease onset. The differences of chloride quantity between A and C groups were significance( P<0.05), and there were no differences among A and B groups, B and C groups(P>0.05). It means that the chloride quantity became normal gradually. The differences of white cell count among A and B groups, A and C groups, B and C groups were hither significance (P<0.01). The CSF cytology showed chronic inflammation changes. It means that the white cells gradually became normal after treatment. The head image alteration had no difference among 3 groups. Conclusion: The CSF culture positive was higher than ever at the initial stage of the disease (during the first 2 weeks). The high protein quantity in CSF could contribute to the diagnosis of TBM by immunology methods. The changes of glucose, chloride, white cells and cytology in CSF would be the gist of restoration or prolongation for the disease. The head image could be conductive to the diagnosis of TBM too.