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57例隐球菌性和结核性脑膜炎脑脊液指标的动态研究

注意：本论文已在《世界感染杂志》2002,Vol.2,No.3:111-114,160发表
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贺斌 赵忠新 邵福源
第二军医大学附属长征医院神经内科,上海,200003

摘要：目的：对脑脊液多项指标进行动态比较，研究隐球菌性和结核性脑膜炎的鉴别要点。方法：对28例隐球菌性和29例结核性脑膜炎病人进行回顾性研究，比较其在入院3 wk内脑脊液指标实验室检测结果的动态变化，采用Logistic回归分析隐球菌性脑膜炎病人入院1 wk内脑脊液蛋白显著增高（?1g/L）的影响因素。结果：在入院wk 1,隐球菌性脑膜炎的脑脊液白细胞总数、红细胞数、中性粒细胞百分数、淋巴细胞百分数及糖含量很难与结核性脑膜炎相鉴别；隐球菌性脑膜炎的脑脊液氯化物含量较结核性脑膜炎显著增高；结核性脑膜炎的脑脊液蛋白含量较隐球菌性脑膜炎显著增高。对二组病人在入院3 wk内的动态比较发现：(1)经治疗后，隐球菌性脑膜病人的脑脊液白细胞总数、中性粒细胞百分数及红细胞数呈进行性降低，而淋巴细胞百分数无显著变化；结核性脑膜炎病人虽经治疗，而上述指标均无显著变化。(2)隐球菌性脑膜病人脑脊液糖和氯化物含量无显著变化，而蛋白含量呈进行性增高。(3)结核性脑膜炎病人脑脊液糖和蛋白含量无显著变化，而氯化物含量呈进行性降低。隐球菌性脑膜炎病人入院1wk内脑脊液蛋白?1g/L的影响因素与病人年龄和淋巴细胞百分数相关。结论：与隐球菌性脑膜炎相比，若病人在入院wk1内其脑脊液蛋白含量?1g/L或在入院3 wk内其脑脊液氯化物呈进行性降低，应高度疑诊为结核性脑膜炎；与结核性脑膜炎相比，若病人在入院3 wk内其脑脊液蛋白呈进行增高，应高度疑诊为隐球菌性脑膜炎。
关键词 隐球菌性脑膜炎 结核性脑膜炎 脑脊液 鉴别诊断

Dynamic study of cerebral spinal fluid marker in 57 patients with cryptococcal and tuberculous meningitis

He bin，Zhao zhong-xin, Shao fu-yuan. Department of Neurology, Changzheng hospital, Second Military Medical University, Shanghai, 200003.

Abstract: Objective: To study the main differential points between the cryptococcal and tuberculous meningitis by means of dynamic comparision of the multiple cerebrospinal fluid(CSF) markers. Method: 57 patients with the cryptococcal and tuberculous meningitis were analyzed retrospectively. The dynamic changes of the laboratory findings of CSF were compared within 3 weeks in 57 patients after admission. The logistic regression method was employed to analyze effecting factors of the significant elevation of the CSF proteins level(?1g/L) in patients with cryptococcal meningitis in the first week after admission. Result: in the first week after admission, no statistical significance was found among the total CSF WBC counts, the CSF neutrophile percentage , the CSF lymphocyte percentage, the CSF RBC counts , or the CSF glucose level in cryptococcal meningitis as compared to those in tuberculous one. The CSF chloride level was higher in cryptococcal meningitis than that in tuberculous one. By contrast, the CSF protein level was higher in the latter than that in the former. The dynamic comparasive results of the multiple CSF markers between the two groups within 3 weeks after admission were as follows: (1) The total CSF WBC counts, the CSF RBC counts, or the CSF neutrophile percentage in cryptococcal meningitis were decreasing continuously after antifungal therapy while the CSF lymphocyte percentage showed no change statistically. There was none change among those CSF cellular markers mentioned above in tuberculous meningitis in the same time after the anti-tubercle therapy. (2) Neither the CSF chloride nor the CSF glucose level was elevated significantly in cryptococcal meningitis while the CSF protein level increased continuously. (3) No significant change was noticed in either the CSF protein or the CSF glucose level in tuberculous meningitis although the CSF chloride level decreased continuously. The lymphocye percentag and the patient's age were found in correlation with the significant elevation of the CSF protein level(?1g/L) in patients with cryptococcal meningitis within the first week after admission. Conclusion: As compared to cryptococcal meningitis, tuberculous meningitis should be highly suspected if the CSF protein level was more than ?1g/L within the first week after admission, or the CSF chloride level decreased continuously within 3 weeks after admission. By contrast to tuberculous meningitis, cryptococcal meningitis should be highly suspected if the CSF protein level increased continuously within 3 weeks after admission.
Key word: tuberculous meningitis cytpcoccal meningitis cerebrospianl fluid diferential diagnosis

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