中国现代神经疾病杂志2012年4月第12卷第2期ChinJContempNeurolNeurosurg,April2012,Vol.12,No.2结核性脑膜炎临床及脑脊液细胞学分析杨笑吴若芬孔繁元谢鹏·临床研究·基金项目：宁夏自然科学基金资助项目（项目编号：NZ10150）作者单位：400016重庆医科大学附属第一医院神经内科（杨笑，谢鹏）；750004银川，宁夏医科大学总医院神经中心（吴若芬，孔繁元）通讯作者：谢鹏（Email：xiepeng58@21cn.com）【摘要】目的分析结核性脑膜炎患者临床表现、早期脑脊液细胞学改变及演变过程，提高对其早期识别能力及诊疗效果的判断。方法回顾分析60例结核性脑膜炎患者的临床特征、病原学检查及脑脊液生化尤其是细胞学动态变化资料。结果60例患者中58例（96.67%）以发热、头痛发病，1周内并发意识障碍者9例（15.00%），伴抽搐5例（8.33%）、眼动障碍8例（13.33%）、偏瘫7例（11.67%），44例（73.33%）既往有肺结核病史。实验室检查脑脊液浓缩集菌抗酸染色阳性8例（13.33%）、结核分枝杆菌培养阳性5例（8.62%）、脑脊液结核分枝杆菌DNA阳性5例（8.77%）。脑脊液改变以颅内压、蛋白定量升高、葡萄糖降低为主；细胞学变化呈现以淋巴细胞增多为主的混合细胞学反应，发病早期脑脊液中性粒细胞比例<0.40，经抗结核药物治疗后细胞总数及中性粒细胞比例短期内（最长随访2个月）可无明显改变。经正规抗结核药物治疗，44例患者好转、11例迁延不愈并出院或转院、5例死亡；发病3周内接受抗结核药物治疗的患者预后明显优于发病3周后接受治疗者。结论结核性脑膜炎患者临床表现无特异性，病原学阳性检出率极低，早期诊断困难。肺结核病变对明确诊断具有辅助价值，脑脊液混合细胞学反应可高度提示诊断。经抗结核药物治疗后脑脊液细胞学演变缓慢，可长期呈混合细胞学反应，不能以此为据推翻结核性脑膜炎的诊断。治疗时机很大程度上决定治疗效果。【关键词】结核，脑膜；脑脊髓液；白细胞计数；细胞诊断学DOI：10.3969/j.issn.1672⁃6731.2012.02.021TheclinicalandcerebrospinalfluidcytologicalfeaturesoftuberculousmeningitisYANGXiao1,WURuo⁃fen2,KONGFan⁃yuan2,XIEPeng11DepartmentofNeurology,theFirstAffiliatedHospitalofChongqingMedicalUniversity,Chongqing400016,China2DepartmentofNeurology,GeneralHospitalofNingxiaMedicialUniversity,Yinchuan750004,Ningxia,ChinaCorrespondingauthor:XIEPeng(Email:xiepeng58@21cn.com)【Abstract】ObjectiveToanalyzetheclinicalandcerebrospinalfluid(CSF)cytologicalfeaturesofpatientswithtuberculousmeningitis(TBM),toimproveearlydiagnosticaccuracyandtreatmentofTBM.MethodsClinicalpresentations,etiologyandbiochemicalandcytologicalfeaturesofCSFwereanalyzedretrospectivelyamong60adultcaseswithTBMhospitalizedatNeurologyDepartmentofGeneralHospitalofNingxiaMedicalUniversityfromJanuary2005toMay2011.ResultsMostpatients(58/60,96.67%)hadfeverandheadacheatonset.Insomepatients,disturbanceofconsciousness(9/60,15.00%),seizure(5/60,8.33%)occurredin1weekandfocalneurologicalsignsdevelopedduringthecourse.Forty⁃fourpatients(73.33%)hadpulmonarytuberculosishistory.InCSFexamination,acid⁃fastbacilluspositivewasfoundin8patients.Positiveacid⁃fastmyobacteriumtuberculousculturewasdetectedin5patientsandpositivemyobacteriumtuberculosisDNAwereseenin5patients.ThemainchangesofCSFwereintracranialhypertension,increaseofprotein,anddecreaseofglucose.CSFpresentedmixedcellularresponsewithpredominaceintheincreasingofleucocytes.DuringearlystagethemeanpercentageofneutrophilinCSFwaslessthan40%.Aftershortterm(aslongas2months)ofregularantituberculotictherapynosignificantchangesintotalcellcountandtheproportionofneutrophilswereseen.In60patients,44patientswereameliorated,11werenothealedorweredischargedortransferredtootherhospitaland5weredead.Prognosisofpatientstreatedwithin3we...
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