CAJ | 학술논문

目的探讨脑脊液细胞学及特殊染色方法诊断结核性脑膜炎(结脑)、化脓性脑膜炎(化脑)和隐球菌性脑膜炎(隐脑)的临床价值.方法对三种疾病共179例患者脑脊液细胞学资料进行回顾性分析.所有病例均进行脑脊液细胞学MGG染色、阿立新兰染色和墨汁染色的动态观察,70例结脑同时应用免疫荧光和免疫细胞化学方法进行结核抗原的检测.结果 ①结脑特征性的细胞学表现为混合细胞反应.早期嗜中性粒细胞比例可达80%以上,随治疗逐渐下降,1～2个月后以淋巴样细胞反应为主.免疫荧光法和免疫细胞化学法检测脑脊液单核细胞内结核抗原,敏感性分别为82.9%和85.7%.②化脑急性期脑脊液中以嗜中性粒细胞为主,抗生素治疗后迅速下降.③MGG染色、阿立新兰染色和涂片墨汁染色诊断隐脑的阳性率分别为83.3%、81.8%和76.5%.结论脑脊液细胞学的动态观察联合应用特殊染色方法,可大大提高颅内感染性疾病的诊断和鉴别诊断,并对治疗及预后判断有指导意义.
목적 탐토뇌척액세포학급특수염색방법진단결핵성뇌막염(결뇌)、화농성뇌막염(화뇌)화은구균성뇌막염(은뇌)적림상개치.방법 대삼충질병공179례환자뇌척액세포학자료진행회고성분석.소유병례균진행뇌척액세포학MGG염색、아립신란염색화묵즙염색적동태관찰,70례결뇌동시응용면역형광화면역세포화학방법진행결핵항원적검측.결과 ①결뇌특정성적세포학표현위혼합세포반응.조기기중성립세포비례가체80%이상,수치료축점하강,1～2개월후이림파양세포반응위주.면역형광법화면역세포화학법검측뇌척액단핵세포내결핵항원,민감성분별위82.9%화85.7%.②화뇌급성기뇌척액중이기중성립세포위주,항생소치료후신속하강.③MGG염색、아립신란염색화도편묵즙염색진단은뇌적양성솔분별위83.3%、81.8%화76.5%.결론 뇌척액세포학적동태관찰연합응용특수염색방법,가대대제고로내감염성질병적진단화감별진단,병대치료급예후판단유지도의의.
Objective To study the clinical value of cerebrospinal fluid cytology(csfc)and specific stain in tuberculous meningitis(TBM)-purulent meningitis(PM)and cryptococcal meningitis(CM).Methods The csfc data of 179 patients with TBM,PM and CM were retrospectively analyzed.The samples collected from all of these patients were analyzed by csfc May-Grunwald-Giemsa(MGG)staining,aricine blue staining and Indian ink staining. And the cytospin smears from 70 TBM were simultaneously stained by the immunofluorescence(IF)and immunocytological method to demonstrate the presence of mycobacterial antigen.Results ①TBM group showed a mixed-cell response.At the early stage of disease,the proportion of neutrophilic granulocyte reached 80%,and then reduced gradually.Lyumphoidocyte reaction was the most obvious in 1～2 months.The immunofluorescence(IF)and immunocytological method present a sensitivity of 82.9%and 85.7%,respectively.②Neutrophilic granulocyte was the most cell at acute stage of PM,and it descended quickly once treated with effective antibiotics.③The positive rates to detect CM with csfc MGG,aricine and Indian ink staining were 83.3%,81.8%,and 76.5%,respectively.Conclusion Dynamic observation on cerebrospinal fluid cytology is helpful to boost the differential diagnosis of intracranial infection.