儿童病毒性脑炎脑脊液细胞计数、免疫球蛋白水平与临床以及预后的相关分析

Analysis of Correlation Between Cerebrospinal Fluid Leukocyte Count, Immunoglobulin Level and Clinical and Prognosis in Children with Viral Encephalitis

目的 探讨病毒性脑炎患儿脑脊液白细胞计数、免疫球蛋白水平与临床症状以及预后的相关性及临床指导意义.方法 196 例病毒性脑炎患儿纳入研究.按患儿入院当天的脑脊液白细胞计数进行分组,分别为轻度升高组[(15~99)×10^6/L]、中度升高组[(100~299)×10^6/L]、高度升高组[(300~900)×10^6/L].明确诊断后规范化地予以抗病毒、降颅压等综合治疗.观察患儿临床症状缓解情况,随访患儿脑脊液白细胞计数恢复情况.同时根据临床症状表现是否提示可能累及深部脑组织将患儿分为重症组及轻症组.采用免疫散射比浊法测定脑脊液及血清IgG浓度,全自动生化分析仪测定血清及脑脊液白蛋白浓度,并计算QIgG、QAlb数值.结果 脑脊液白细胞计数与临床症状及预后无明显相关性,QIgG、QAlb与患儿临床症状的严重程度以及预后有相关性.结论 患儿脑脊液白细胞计数对病毒性脑炎有诊断性意义,可以达到早期、快速诊断的目的,但其数值高低同临床及预后无明显相关性.但QIgG、QAlb可以提示临床症状的严重程度以及可能的预后,指导临床治疗工作.

Objective To investigate the relationship between cerebrospinal fluid (CSF) leukocyte count, immunoglobulin levels and clinical symptoms and prognosis in children with viral encephalitis and its clinical significance. Methods 196 children with viral encephalitis were enrolled in this study. According to CSF leukocyte count on the day of admission, the children were divided into slightly elevated group [(15~99) ×10^6/L], moderately elevated group [(100~299) ×10^6/L] and severely elevated group [(300~900) ×10^6/L]. They were provided with standardized treatments such as antiviral therapy and decreasing intracranial pressure after primary diagnosis. The remission of clinical symptoms of the children was observed and the recovery of CSF leukocyte count was followed up. At the same time, the children were divided into severe group and mild group according to whether the clinical symptoms suggested that deep brain tissue might be involved. The concentration of IgG in CSF and serum was determined by immunoturbidimetry, the concentration of albumin in CSF and serum was determined by automatic biochemical analyzer, and the values of QIgG and QAlb were calculated. Results There was no significant correlation between CSF leukocyte count and clinical symptoms and prognosis. QIgG and QAlb were correlated with the severity of clinical symptoms and prognosis. Conclusion CSF leukocyte count in children has an important value in early and rapid diagnosis of viral encephalitis, but its value has no significant correlation with clinical and prognosis. However, QIgG, QAlb can indicate the severity of clinical symptoms and possible prognosis, and guide clinical treatment.