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57例隱球菌性和結核性腦膜炎腦脊液指標的動態研究

注意:本論文已在《世界感染雜志》2002,Vol.2,No.3:111-114,160發表
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賀斌 趙忠新 邵福源
第二軍醫大學附屬長征醫院神經內科,上海,200003

摘要:目的:對腦脊液多項指標進行動態比較,研究隱球菌性和結核性腦膜炎的鑒別要點。方法:對28例隱球菌性和29例結核性腦膜炎病人進行回顧性研究,比較其在入院3 wk內腦脊液指標實驗室檢測結果的動態變化,采用Logistic回歸分析隱球菌性腦膜炎病人入院1 wk內腦脊液蛋白顯著增高(?1g/L)的影響因素。結果:在入院wk 1,隱球菌性腦膜炎的腦脊液白細胞總數、紅細胞數、中性粒細胞百分數、淋巴細胞百分數及糖含量很難與結核性腦膜炎相鑒別;隱球菌性腦膜炎的腦脊液氯化物含量較結核性腦膜炎顯著增高;結核性腦膜炎的腦脊液蛋白含量較隱球菌性腦膜炎顯著增高。對二組病人在入院3 wk內的動態比較發現:(1)經治療后,隱球菌性腦膜病人的腦脊液白細胞總數、中性粒細胞百分數及紅細胞數呈進行性降低,而淋巴細胞百分數無顯著變化;結核性腦膜炎病人雖經治療,而上述指標均無顯著變化。(2)隱球菌性腦膜病人腦脊液糖和氯化物含量無顯著變化,而蛋白含量呈進行性增高。(3)結核性腦膜炎病人腦脊液糖和蛋白含量無顯著變化,而氯化物含量呈進行性降低。隱球菌性腦膜炎病人入院1wk內腦脊液蛋白?1g/L的影響因素與病人年齡和淋巴細胞百分數相關。結論:與隱球菌性腦膜炎相比,若病人在入院wk1內其腦脊液蛋白含量?1g/L或在入院3 wk內其腦脊液氯化物呈進行性降低,應高度疑診為結核性腦膜炎;與結核性腦膜炎相比,若病人在入院3 wk內其腦脊液蛋白呈進行增高,應高度疑診為隱球菌性腦膜炎。
關鍵詞 隱球菌性腦膜炎 結核性腦膜炎 腦脊液 鑒別診斷

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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