玻片离心沉淀法脑脊液细胞学检查在小儿中枢神经系统感染性疾病中的诊断价值

Diagnostic value of cytological examination of cerebrospinal fluid by slide centrifugation in infectious diseases of central nervous system in children

目的探讨玻片离心沉淀法脑脊液细胞学检查在小儿中枢神经系统感染性疾病诊断中的应用价值。方法选择2015年5月-2019年5月于湖南省儿童医院住院治疗的185例中枢神经系统感染性疾病患儿作为研究对象,根据疾病类型分为化脓性脑膜炎组62例,病毒性脑膜炎组62例,结核性脑膜炎组61例。3组患儿入院后腰椎穿刺取1 mL脑脊液,各取0.5 mL分别采用玻片离心沉淀法及常规细胞计数法观察脑脊液中细胞形态并对异常细胞进行计数和比较,同时统计玻片离心沉淀法观察到的各组患儿脑脊液细胞学分类检查结果。另选60例经检查无中枢神经系统感染性疾病小儿的脑脊液细胞学分类检查结果进行比较。结果玻片离心沉淀法对3组中枢神经系统感染性疾病患儿脑脊液中异常细胞的检出率均明显高于常规细胞计数法〔化脓性脑膜炎组:100.0%(62/62)比72.6%(45/62),病毒性脑膜炎组:100%(62/62)比33.9%(21/62),结核性脑膜炎组:100%(61/61)比21.3%(13/61)〕,差异均有统计学意义(均P<0.05)。化脓性脑膜炎患儿脑脊液中嗜中性粒细胞明显增多,而淋巴样细胞未见明显增多;病毒性脑膜炎患儿脑脊液中小淋巴细胞所占比例最高;结核性脑膜炎患儿脑脊液异常细胞特点是淋巴细胞为主的混合细胞学反应。结论玻片离心沉淀法检查脑脊液细胞成分可以更好地分辨出各类脑脊液异常细胞,对于感染类型的辨别具有重要的临床价值,对临床诊断小儿中枢神经系统感染性疾病具有指导意义。

Objective To investigate the application value of cytological examination of cerebrospinal fluid by slide centrifugation in diagnosis of infectious diseases of central nervous system in children.Methods The 185 children with central nervous system infection hospitalized in Hunan Children's Hospital from April 2018 to April 2019 were selected as research objects.According to disease type,the children were divided into suppurative meningitis group(62 cases),viral meningitis group(62 cases)and tuberculous meningitis group(61 cases).By lumbar puncture,1 mL of cerebrospinal fluid was taken after admission of three groups of children,and 0.5 mL of each was used to observe the morphology of cells in cerebrospinal fluid and the abnormal cells were calculated and compared by slide centrifugation method and conventional cell count method,respectively.At the same time,the cytological examination results of each group observed by slide centrifugation method were analyzed.The cytological examination results of cerebrospinal fluid in other 60 children without infection were compared.Results The detection rates of abnormal cells in cerebrospinal fluid of three groups of children with infectious diseases of central nervous system by slide centrifugation were significantly higher than those by conventional cell count method[suppurative meningitis group:100.0%(62/62)vs.72.6%(45/62),viral meningitis group:100.0%(62/62)vs.33.9%(21/62),tuberculous meningitis group:100.0%(61/61)vs.21.3%(13/61)],with significant differences(all P<0.05).In children with suppurative meningitis,the number of neutrophils in cerebrospinal fluid was significantly increased,but the number of lymphoid cells was not significantly increased;in children with viral meningitis,the proportion of lymphocytes in cerebrospinal fluid was the highest;in children with tuberculous meningitis,there were mixed cell reaction dominated by lymphocytes.Conclusion The method of slide centrifugation can distinguish all kinds of the abnormal cerebrospinal fluid cells better,which is of great clinical value for the identification of infection types and has guiding significance in the clinical diagnosis of central nervous system infection in children.