小儿结核性脑膜炎及病毒性脑膜炎脑脊液细胞学变化对比

Comparison of cerebrospinal fluid cytology between the children with tuberculous meningitis and those with viral meningitis

目的对比分析小儿结核性脑膜炎与病毒性脑膜炎脑脊液中细胞比重差异,为临床鉴别诊断提供参考依据。方法选取2015年12月至2016年12月湖南省儿童医院收治的结核性脑膜炎和病毒性脑膜炎各20例,分别为结核组和病毒组。观察两组患儿的脑脊液细胞学差异。(1)分析两组患儿脑脊液小淋巴细胞、淋巴样细胞、转化淋巴细胞、激活单核细胞、嗜中性粒细胞的百分比情况。(2)检测两组患儿的血清白蛋白(C_(ALB))、脑脊液白蛋白(S_(ALB))及脑脊液白蛋白指数(C_(ALB)指数)。(3)评估两组患儿的血脑屏障损伤程度。结果与病毒组患儿相比,结核组患儿脑脊液中淋巴类细胞较少,激活单核细胞和嗜中性粒细胞较多,差异有统计学意义(P<0.05);两组患儿脑脊液中浆细胞和单核细胞数量比较,差异无统计学意义(P>0.05)。结核组患儿的S_(ALB),C_(ALB)指数显著高于病毒组,差异有统计学意义(P<0.05);两组患儿的C_(ALB)比较差异无统计学意义(P>0.05)。结核组患儿的血脑屏障损伤程度明显重于病毒组,差异有统计学意义(P<0.05)。此外,治疗8周后两组患儿脑脊液中小淋巴细胞、淋巴样细胞、转移淋巴细胞、激活单核细胞较治疗前均明显升高,嗜中性粒细胞明显降低,差异有统计学意义(P<0.05);治疗后两组患儿各种细胞数目比重比较差异无统计学意义(P>0.05)。结论结核性脑膜炎与病毒性脑膜炎患儿发病时脑脊液细胞比重存在显著差异,采用脑脊液细胞学检查技术可为鉴别诊断小儿结核性脑膜炎与病毒性脑膜炎提供重要理论参考依据,对临床治疗具有重要价值。

To observe and analyze the cytological characteristics of cerebrospinal fluid(CSF)in children with tuberculous meningitis and viral meningitis.Methods Twenty cases of tuberculous meningitis and 20 cases of viral meningitis admitted to Children's Hospital of Hunan Province from December 2015 to December 2016 were selected as the TB group and virus group respectively.The cytological differences of cerebrospinal fluid between the two groups were observed.(1)The percentage of small lymphocytes,lymphoid cells,transformed lymphocytes,monocytes activated and neutrophils in cerebrospinal fluid was analyzed in the two groups.(2)Serum albumin(CALB),cerebrospinal albumin(SALB)and cerebrospinal albumin index(CALB index)were detected in the two groups of children.(3)Evaluate the severity of blood-brain barrier injury in the two groups.Results Compared with the children in the virus group,the children in the tuberculosis group had fewer lymphoid cells in the cerebrospinal fluid and more activated monocytes and neutrophils,and the difference was statistically significant(P<0.05).The number of plasma cells and monocytes in cerebrospinal fluid of the two groups was not statistically different(P>0.05).S ALB and C ALB index were significantly higher in the tuberculosis group than in the virus group,and the difference was statistically significant(P<0.05).There was no significant difference in C ALB between the two groups(P>0.05).The severity of blood-brain barrier injury in the tuberculosis group was significantly higher than that in the virus group,and the difference was statistically significant(P<0.05).In addition,the small and medium lymphocytes,lymphoid cells,metastatic lymphocytes,and activated monocytes of cerebrospinal fluid were significantly increased in both groups after 8 weeks of treatment,and the neutrophilic granulocytes were significantly decreased,with statistically significant differences(P<0.05).There was no significant difference in the proportion of various cells in the two groups after treatment(P>0.05).Conclusion Cytological examination of cerebrospinal fluid can provide a reference for differential diagnosis of tuberculous meningitis and viral meningitis in children,which is of great value in clinical treatment.