细胞学检测在小儿结核性脑膜炎中的诊断价值及与病毒性脑膜炎对比研究

The diagnostic value of cytology in children with tuberculous meningitis and its comparison with viral meningitis

目的分析小儿结核性脑膜炎、病毒性脑膜炎的诊断中进行细胞学检测的价值。方法选择2013-04—2019-04商丘市第三人民医院收治的结核性脑膜炎患儿20例(结核组),病毒性脑膜炎患儿30例(病毒组)为对象,均进行细胞学检测,比较2组细胞类型、血清白蛋白、脑脊液白蛋白、脑脊液白蛋白指数、血脑屏障损伤程度。结果结核组CALB与病毒组比较差异无统计学意义(P>0.05),结核组SALB、CALB指数明显高于病毒组(P<0.05);结核组小淋巴细胞、淋巴样细胞、转化淋巴细胞均低于病毒组(P<0.05),激活单核细胞、嗜中性粒细胞均高于病毒组脑膜炎患儿(P<0.05),结核组与病毒组浆细胞、单核细胞比重差异无统计学意义(P>0.05);结核组血脑屏障轻度损伤比重为16.67%,明显低于病毒组比重(46.67%),差异有统计学意义(P<0.05),结核组中度损伤与重度损伤比重分别为40.00%、43.33%,均多于病毒组(30.00%、23.33%),但差异无统计学意义(P>0.05)。结论细胞学检测能够帮助鉴别小儿结核性脑膜炎、病毒性脑膜炎,为临床诊疗进行提供科学指导。

Objective To analyze the value of cytology in the diagnosis of tuberculous meningitis and viral meningitis in children.Methods 30 patients with tuberculous meningitis(tuberculosis group)and 30 children with viral meningitis(virus group)admitted to the Third People's Hospital of Shangqiu City from April 2013 to April 2019 were selected for cytology.The cell types,serum albumin,cerebrospinal fluid albumin,cerebrospinal fluid albumin index,and blood-brain barrier damage were compared between the two groups.Results There was no statistically significant difference between the CALB group and the virus group(P>0.05),and the SALB and CALB indexes of the tuberculosis group were significantly higher than those of the virus group(P<0.05).The number of small lymphocytes,lymphoid cells and transformed lymphocytes in the tuberculosis group was lower than that in the viral group(P<0.05),and the number of activated monocytes and neutrophils was higher than that in the viral group(P<0.05).There was no statistically significant difference in the proportion of plasma cells and monocytes between the tuberculosis group and the viral group(P>0.05).The proportion of mild BBB injury in the tuberculosis group was 16.67%,significantly lower than that in the virus group(46.67%),and the difference was statistically significant(P<0.05).The proportion of moderate injury and severe injury in the tuberculosis group was 40.00%and 43.33%,respectively,more than that in the virus group(30.00%and 23.33%),but the difference was not statistically significant(P>0.05).Conclusion Cytology can help to identify tuberculous meningitis and viral meningitis in children and provide scientific guidance for clinical diagnosis and treatment.