结核性脑膜炎和疱疹病毒脑膜脑炎脑脊液细胞学检查的特点分析  

Cytological features of cerebrospinal fluid in tuberculous meningitis and herpes virus meningoencephalitis

作　　者：李朝阳 赵之晗 冯国栋 杜芳 王静 张红鸭 杨毅宁 代文 刘婷婷 贺莹 周慧敏 边婷 安星月 蔡铮 赵钢 LI Chao-Yang;ZHAO Zhi-Han;FENG Guo-Dong;DU Fang;WANG Jing;ZHANG Hong-Ya;YANG Yi-Ning;DAI Wen;LIU Ting-Ting;HE Ying;ZHOU Hui-Min;BIAN Ting;AN Xing-Yue;CAI Zheng;ZHAO Gang(Department of Neurology,Xijing Hospital,The Fourth Military Medical University,Xi'an,710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院神经内科,陕西省西安市710032 [2]复旦大学附属中山医院神经内科,上海市200032 [3]中国人民解放军第四五一医院神经内科,陕西省西安市710054

出　　处：《国际神经病学神经外科学杂志》2018年第6期551-555,共5页Journal of International Neurology and Neurosurgery

基　　金：国家重点研发计划(2016YFC0904500);国家自然科学基金(81771311)

摘　　要：目的观察分析结核性脑膜炎(TBM)和疱疹病毒脑膜脑炎(HVME)的脑脊液细胞学特点。方法对经下一代基因测序技术确诊的28例TBM和27例HVME患者进行脑脊液细胞学检查及动态观察。结果 TBM组脑脊液嗜中性粒细胞比例显著高于HVME组(P <0. 01),而小淋巴细胞比例低于HVME组(P <0. 01)。HVME组有6例(22. 22%)患者查见红细胞和/或含铁血黄素吞噬细胞,有2例查见细胞内包涵体,而TBM组则均未查见。脑脊液细胞学动态观察发现,TBM组白细胞计数和嗜中性粒细胞比例下降的速度、小淋巴细胞比例上升的速度均较HVME组缓慢,且呈波动性。结论TBM和HVME的脑脊液细胞反应类型不同,TBM表现为混合型细胞反应,HVME则以淋巴细胞反应为主。HVME并发出血的机率显著高于TBM,而且常见细胞内包涵体。动态观察结果表明脑脊液细胞学检查可做为病情观察、疗效判定和预后评估的客观指标,具有十分重要的临床意义。Objective To investigate the cytological features of cerebrospinal fluid in tuberculous meningitis( TBM) and herpes viral meningoencephalitis( HVME). Methods A total of 28 patients with TBM and 27 with HVME were enrolled,and next-generation sequencing was used for cytological examination and dynamic observation of cerebrospinal fluid. Results Compared with the HVME group,the TBM group had a significantly higher proportion of neutrophils and a significantly lower proportion of small lymphocytes in cerebrospinal fluid( P < 0. 01). Among the patients in the HVME group,6(22. 22%) were found to have phagocytic cells containing red blood cells and/or hemosiderin and 2 were found to have intracellular inclusion bodies,which were not found in the TBM group.Dynamic observation of cerebrospinal fluid cytology showed that compared with the HVME group,the TBM group had lower rates of reductions in leukocyte count and the proportion of neutrophils and a lower rate of increase in the proportion of small lymphocytes,with fluctuations. Conclusions TBM and HVME have different types of cell reaction in cerebrospinal fluid,with mixed cell reaction in TBM and mainly lymphocyte reaction in HVME. HVME is more likely to cause hemorrhage than TBM,and intracellular inclusion bodies are often observed in HVME. Dynamic observation of cerebrospinal fluid cytology has important clinical significance and can provide objective indices for disease monitoring,therapeutic effect evaluation,and prognosis evaluation.

关 键 词：结核性脑膜炎 疱疹病毒脑膜脑炎 脑脊液细胞学 

分 类 号：R529.3[医药卫生—内科学] R512.3[医药卫生—临床医学]