浅谈应用脑脊液细胞学检查诊断中枢神经系统疾病的临床价值  

Application of Cytological Examination of Cerebrospinal Fluid in Diagnosis of Central Nervous System Disease

作　　者：陈松盛[1] 王锐利[1] 沈亚宁[1] 王辉[1] 何娅[1] 

机构地区：[1]西安交通大学第二附属医院老年病科,陕西西安710004

出　　处：《当代医药论丛》2014年第12期74-75,共2页

摘　　要：目的 :探讨分析应用脑脊液细胞学检查(Cerebrospinalfluid cytology,CSFC)诊断中枢神经系统疾病的临床价值。方法 :选取近年来我院收治的中枢神经系统疾病患者46例作为研究对象,为其进行常规腰椎穿刺,将得到的脑脊液应用FMU-5细胞玻片离心仪直接进行离心制片,然后进行MGG染色,最后在显微镜下进行阅片和细胞分类,并将检查的结果及所有患者的临床资料进行回顾性的分析。结果 :经检查,在这46例患者中,患有病毒性脑膜炎的患者有29例,其脑脊液中的白细胞总数为(12~380)×106/L,以淋巴细胞为主,可见激活淋巴细胞,淋巴细胞的占比为58%~87%,单核细胞的占比为10%~40%,可见少量的中性粒细胞,其占比为0%~2%,部分病例可见浆细胞,其占比为0.5%;患有化脓性脑膜炎的患者有8例,其脑脊液中的白细胞总数为(256~930)×106/L,早期以中性粒细胞为主,最高可占93%,随着抗菌素的使用,中性粒细胞的占比会逐渐降低,单核-吞噬细胞的比例逐渐增加,进入恢复期后,单核-吞噬细胞的比例明显增高,可见少量的淋巴细胞,中性粒细胞逐渐消失;患有结核性脑膜炎的患者有5例,其脑脊液中的白细胞总数(24~245)×106/L,含有中性粒细胞、淋巴细胞、单核细胞等混合细胞;患有脑膜癌的患者有1例,可见大小不一、核增多、增大、深染、核膜增厚、不规则的肿瘤细胞;发生蛛网膜下腔出血的患者有2例,其中1例出血早期患者的脑脊液中可见大量的红细胞,另外1例出血第5天患者的的脑脊液中可见红细胞吞噬细胞。结论 :脑脊液细胞学检查能通过特殊的收集方法最大程度地收集脑脊液细胞,具有操作简便、快速、准确等优点,对临床诊断中枢神经系统疾病具有重要的意义和价值。【Objective】: Analyze the characteristics of cytological examination of cerebrospinal fluid of central nervous, such as cephalomeningitis. Observe the diagnostic value of applying cerebrospinal fluid cytological examination of central nervous system disease. Methods: Using conventional lumbar puncture, we obtained cerebrospinal fliud samples of 46 patients with central nervous system disease presenting as meningitis. The slides with cerebrospinal fluid were centrifuged with FMU-5 cell slice centrifugal instrument and stained by MGG. The cells in the cerebrospinal fluid were observed and classified under microscopy. Results: Cerebrospinal fluid cytology in different causes of meningitis has different characteristics, for example, lymphocytes were found dominated in 29 cases of cerebrospinal fluid of early viral meningitis, neutrophils were found dominated in 8 cases of cerebrospinal fluid of early purulent meningitis, mixed cells were found dominated in 5 cases of cerebrospinal fluid of tuberculous meningitis. In 1 case of cerebrospinal fluid of meningioma, the tumor cells were detected with huge hyperchronatic and irregular nucleus. Red blood cells and red blood cell phagocytosed cells were detected in 3 cases of cerebrospinal fluid of subarachnoid hemorrhage. Conclusion: The number of cell harvesting were increased by cytological examination of cerebrospinal fluid, which improved the diagnostic value of cerebrospinal fluid cytology. The experimental results showed that the whole method was convenient, precise and effective to diagnose the central nervous system disease and judge the therapeutic effect.

关 键 词：脑脊液细胞学检查 病毒性脑膜炎 化脓性脑膜炎 结核性脑膜炎 诊断价值 

分 类 号：R446.14[医药卫生—诊断学]