30例耐药结核性脑膜炎脑脊液细胞学动态分析

Cytological features of cerebrospinal fluid and significance in diagnosis of drug-resistant tuberculous meningitis

目的:探讨脑脊液细胞学动态特点在耐药结核性脑膜炎(简称结脑)临床诊疗中的价值。方法:运用玻片离心沉淀法收集细胞,瑞吉染色,油镜下进行细胞分类,对30例耐药结脑患者的脑脊液细胞学分类特点进行动态观察与分析,以评估治疗效果并指导治疗。结果:耐药结脑患者脑脊液白细胞总数均有升高。早期以嗜中性粒细胞为主,随后大多数单耐药、多耐药结脑患者脑脊液细胞学呈混合细胞学反应,随病情好转,单核细胞、激活单核细胞增多,迅速变成以淋巴细胞为主,但是耐多药、泛耐药的结脑患者的脑脊液多数长期为混合细胞学反应,至患者死亡仍未见明显好转。结论:脑脊液细胞学检查操作简便,其结果能直接反映脑脊液的免疫反应状态,有一定特异性,对耐药结脑的临床诊断、鉴别诊断和指导治疗有重要意义。

Objective： To assess the clinical values by determining the dynamics of cytological changes of the cerebrospinal fluid（ CSF） in diagnosis of the drug-resistant tuberculous meningitis（ TBM）. Methods： By using the cerebrospinal fluid sediment chamber method,the cells were collected from the CSF,and subjected to Wright-Giemsa staining and classification with oil immersion lens. Then the curative effects were assessed in 30 cases of drug-resistant TBM through dynamic observation and analysis on the cytological pictures of the CSF. Results： Total leucocyte count was increased in CSF of TBM patients,and neutrophilic granulocytes were prominent in the early stage of disease,followed by mixed cell reaction in cases of single or multi drug-resistance.With improvement of the disease,monocytes and the activated monocytes were increased,and correspondingly dominated by lymphocytes. However,mixed cell reaction persisted in the CSF from TBM patients with multi-drug or pan-drug resistancen,and this condition failed to reverse till the death of patients.Conclusion： The cytological analysis of CSF can specifically reflect the state of immune response in patients with drug-resistant TBM,and may have clinical implications in differentiation and planning the therapeutic strategy for this entity.