脑脊液不同涂片和染色方法在颅内感染诊断中的比较分析  

Comparative Analysis of Different Smear and Staining Methods of Cerebrospinal Fluid in Diagnosis of Intracranial Infection

作　　者：林卫[1] 邓懋清[1] 陈丽萍[1] 肖婷[1] 卢永芳[1] LIN Wei;DENG Mao-qing;CHEN Li-ping;XIAO Ting;LU Yong-fang(Laboratory Department,Longyan First Hospital,Fujian Medical University,Longyan Fujian 364000,China)

机构地区：[1]福建医科大学附属龙岩市第一医院检验科,福建龙岩364000

出　　处：《抗感染药学》2023年第7期724-728,共5页Anti-infection Pharmacy

基　　金：福建省自然科学基金项目(编号:2019J01615)。

摘　　要：目的:比较和分析脑脊液不同涂片和染色方法在颅内感染诊断中应用情况,为临床颅内感染的准确诊断提供参考。方法:选取2017年9月—2021年8月福建医科大学附属龙岩市第一医院临床送检的845份脑脊液标本作为研究资料,采用不同的涂片和染色方法进行实验,并与常规培养和鉴定的结果进行比较,分析不同涂片和染色方法在颅内感染诊断中的价值。结果:培养和鉴定结果显示,845份脑脊液标本中有99份的微生物培养结果为阳性,共分离出病原菌103株,其中革兰阳性菌79株、革兰阴性菌9株、真菌15株;增菌涂片下革兰染色和瑞氏染色的实验结果与培养鉴定结果的阳性符合率均高于95.00%,而离心涂片下革兰染色、墨汁染色、抗酸染色的实验结果与培养鉴定结果的阳性符合率均低于50.00%;与培养鉴定结果相比,增菌涂片的革兰染色结果与其一致性非常好(Kappa值均>0.90),而离心涂片的革兰染色结果的一致性就相对较差(Kappa值均<0.80)。结论:脑脊液增菌涂片的革兰染色和瑞氏染色有着较高的阳性符合率,可在一定条件下配合培养法帮助医生更好、更准确地诊断颅内感染,从而避免漏诊、误诊。Objective:To compare and analyze the application of different smear and stainingmethods of cerebrospinal fluid in the diagnosis of intracranial infection,so as to provide reference for the accurate clinical diagnosis of intracranial infection.Methods:845 cerebrospinal fluid specimens clinically submitted to Longyan First Hospital from September 2017 to August 2021 were selected as the research data,different smear and staining methods were employed for experiments and compared with the results of routine culture and identification to analyze the value of different smear and staining methods in the diagnosis of intracranial infection.Results:According to the culture and identification results,among 845 cerebrospinal fluid specimens,99 were positive for microbial culture results,and 103 strains of pathogenic bacteria were isolated in total,including 79 strains of Gram-positive bacteria,9 strains of Gram-negative bacteria,and 15 strains of funguses.The positive coincidence rates of the experimental results of Gram staining and Wright's staining under enriched culture smears and the culture and identification results were higher than 95.00%,while the positive coincidence rates of the experimental results of Gram staining,ink staining,and acid-fast staining under centrifugal smears and the culture and identification results were lower than 50.00%;compared with the culture and identification results,the coincidence between the Gram staining results of enriched culture smears was remarkably excellent(Kappa values above 0.90),while the coincidence of the Gram staining results of centrifugal smears was relatively poor(Kappa values below 0.80).Conclusion:Gram staining and Wright's staining of cerebrospinal fluid enriched culture smears have relatively high positive coincidence rates,which can assist physicians in better and more accurate diagnosis of intracranial infection in conjunction with the culture method under certain conditions,so as to avoid missed diagnosis and misdiagnosis.

关 键 词：颅内感染 脑脊液 增菌涂片 离心涂片 革兰染色 瑞氏染色 

分 类 号：R651.19[医药卫生—外科学] R446.5[医药卫生—临床医学]