协和医学杂志
協和醫學雜誌
협화의학잡지
MEDICAL JOURNAL OF PEKING UNION MEDICAL COLLEGE HOSPITAL
2015年
1期
14-17
,共4页
关鸿志%陈琳%崔丽英%管宇宙%李秀丽%钱敏%任海涛%赵燕环
關鴻誌%陳琳%崔麗英%管宇宙%李秀麗%錢敏%任海濤%趙燕環
관홍지%진림%최려영%관우주%리수려%전민%임해도%조연배
吉兰-巴雷综合征%脑脊液%细胞学
吉蘭-巴雷綜閤徵%腦脊液%細胞學
길란-파뢰종합정%뇌척액%세포학
Guillain-Barrésyndrome%cerebrospinal fluid%cytology
目的:探讨吉兰-巴雷综合征(Guillain-Barrésyndrome, GBS)的脑脊液(cerebrospinal fluid, CSF)细胞学特点及其诊断意义。方法回顾性分析北京协和医院2010年1月至2012年12月收治的GBS患者的临床、神经电生理和CSF检查资料。入组病例均符合《中国吉兰-巴雷综合征诊治指南》(2010年)诊断标准。 CSF细胞学检查采用CSF细胞沉淀器(自然沉淀法)制片, MGG法染色。采用χ2检验比较CSF常规计数和CSF细胞学的阳性率。结果共28例GBS患者纳入研究,其中男19例,女9例,平均年龄39岁(8~69岁)。均急性起病,肢体无力22例,感觉减退13例,感觉过敏3例,球麻痹7例,需要呼吸机辅助通气3例,尿潴留5例,体位性低血压1例,眼肌麻痹5例,面瘫10例,共济失调4例。临床分型:急性炎性脱髓鞘性多发神经根神经病20例,急性运动轴索性神经病1例,急性运动感觉轴索性神经病1例,急性感觉神经病1例, Miller Fisher 综合征4例,抗GQ1b抗体阳性的眼肌麻痹1例。 CSF蛋白0.39~4.23 g/L,蛋白升高26例,其中11例蛋白>1.0 g/L; CSF白细胞计数:(0~5)×106/L 26例,(6~10)×106/L 2例。 CSF寡克隆区带阳性者14例,髓鞘碱性蛋白升高者18例。抗GM1抗体阳性3例,抗GQ1b抗体阳性2例。 CSF细胞学检查异常12例,其中9例为淋巴细胞为主的炎症,3例为单核细胞与淋巴细胞为主的炎症,1例见2%的中性粒细胞,6例可见激活的淋巴细胞,2例可见激活的单核吞噬细胞,3例可见浆细胞。病例中CSF细胞数超过5/μl者2例(7.1%), CSF细胞学提示炎性改变者12例(42.9%), CSF细胞学阳性率高于常规细胞计数(P<0.01)。结论 GBS的CSF细胞学检查可见淋巴细胞性炎症等炎性改变,与GBS的多发性神经根炎的病理机制相一致。与CSF常规细胞计数相比, CSF细胞学能够更敏感地显示CSF的炎性状态,因此对于GBS也更具诊断意义。
目的:探討吉蘭-巴雷綜閤徵(Guillain-Barrésyndrome, GBS)的腦脊液(cerebrospinal fluid, CSF)細胞學特點及其診斷意義。方法迴顧性分析北京協和醫院2010年1月至2012年12月收治的GBS患者的臨床、神經電生理和CSF檢查資料。入組病例均符閤《中國吉蘭-巴雷綜閤徵診治指南》(2010年)診斷標準。 CSF細胞學檢查採用CSF細胞沉澱器(自然沉澱法)製片, MGG法染色。採用χ2檢驗比較CSF常規計數和CSF細胞學的暘性率。結果共28例GBS患者納入研究,其中男19例,女9例,平均年齡39歲(8~69歲)。均急性起病,肢體無力22例,感覺減退13例,感覺過敏3例,毬痳痺7例,需要呼吸機輔助通氣3例,尿潴留5例,體位性低血壓1例,眼肌痳痺5例,麵癱10例,共濟失調4例。臨床分型:急性炎性脫髓鞘性多髮神經根神經病20例,急性運動軸索性神經病1例,急性運動感覺軸索性神經病1例,急性感覺神經病1例, Miller Fisher 綜閤徵4例,抗GQ1b抗體暘性的眼肌痳痺1例。 CSF蛋白0.39~4.23 g/L,蛋白升高26例,其中11例蛋白>1.0 g/L; CSF白細胞計數:(0~5)×106/L 26例,(6~10)×106/L 2例。 CSF寡剋隆區帶暘性者14例,髓鞘堿性蛋白升高者18例。抗GM1抗體暘性3例,抗GQ1b抗體暘性2例。 CSF細胞學檢查異常12例,其中9例為淋巴細胞為主的炎癥,3例為單覈細胞與淋巴細胞為主的炎癥,1例見2%的中性粒細胞,6例可見激活的淋巴細胞,2例可見激活的單覈吞噬細胞,3例可見漿細胞。病例中CSF細胞數超過5/μl者2例(7.1%), CSF細胞學提示炎性改變者12例(42.9%), CSF細胞學暘性率高于常規細胞計數(P<0.01)。結論 GBS的CSF細胞學檢查可見淋巴細胞性炎癥等炎性改變,與GBS的多髮性神經根炎的病理機製相一緻。與CSF常規細胞計數相比, CSF細胞學能夠更敏感地顯示CSF的炎性狀態,因此對于GBS也更具診斷意義。
목적:탐토길란-파뢰종합정(Guillain-Barrésyndrome, GBS)적뇌척액(cerebrospinal fluid, CSF)세포학특점급기진단의의。방법회고성분석북경협화의원2010년1월지2012년12월수치적GBS환자적림상、신경전생리화CSF검사자료。입조병례균부합《중국길란-파뢰종합정진치지남》(2010년)진단표준。 CSF세포학검사채용CSF세포침정기(자연침정법)제편, MGG법염색。채용χ2검험비교CSF상규계수화CSF세포학적양성솔。결과공28례GBS환자납입연구,기중남19례,녀9례,평균년령39세(8~69세)。균급성기병,지체무력22례,감각감퇴13례,감각과민3례,구마비7례,수요호흡궤보조통기3례,뇨저류5례,체위성저혈압1례,안기마비5례,면탄10례,공제실조4례。림상분형:급성염성탈수초성다발신경근신경병20례,급성운동축색성신경병1례,급성운동감각축색성신경병1례,급성감각신경병1례, Miller Fisher 종합정4례,항GQ1b항체양성적안기마비1례。 CSF단백0.39~4.23 g/L,단백승고26례,기중11례단백>1.0 g/L; CSF백세포계수:(0~5)×106/L 26례,(6~10)×106/L 2례。 CSF과극륭구대양성자14례,수초감성단백승고자18례。항GM1항체양성3례,항GQ1b항체양성2례。 CSF세포학검사이상12례,기중9례위림파세포위주적염증,3례위단핵세포여림파세포위주적염증,1례견2%적중성립세포,6례가견격활적림파세포,2례가견격활적단핵탄서세포,3례가견장세포。병례중CSF세포수초과5/μl자2례(7.1%), CSF세포학제시염성개변자12례(42.9%), CSF세포학양성솔고우상규세포계수(P<0.01)。결론 GBS적CSF세포학검사가견림파세포성염증등염성개변,여GBS적다발성신경근염적병리궤제상일치。여CSF상규세포계수상비, CSF세포학능구경민감지현시CSF적염성상태,인차대우GBS야경구진단의의。
Objective To investigate the cytological features of cerebrospinal fluid (CSF) in Guillain-Barré syndrome ( GBS) and the role of the cytological features in the diagnosis of GBS .Methods We reviewed the clini-cal , neurophysiological , and CSF cytological findings of GBS patients treated in Peking Union Medical College Hos-pital from January 2010 to December 2012.The included patients all met the diagnostic criteria in 2010 China Guidelines for Diagnosis and Treatment of GBS .CSF cytological tests were performed using sedimentation chamber and MGG staining .CSF routine cell count and CSF cytological-finding positive-rate were compared with Chi-square test.Results Twenty-eight cases of GBS were included , at a mean age of 39 years (8-69 years), including 19 males and 9 females.The 28 patients all had acute onset , with 22 demonstrating limb weakness , 13 hypoesthesia, 3 hyperesthesia , 7 bulbar paralysis , 3 with the need of assisted ventilation, 5 urinary retention, 1 positional hypoten-sion, 5 ophthalmoplegia, 10 facial paralysis, and 4 ataxia.The patients were clinically classified to acute inflammatory demyelinating polyneuropathy (20 cases), acute motor axonal neuropathy (1 case), acute motor-sensory axonal neu-ropathy (1 case), acute sensory neuropathy (1 case), Miller Fisher syndrome (4 cases), and GQ1b antibody-positive ophthalmoplegia (1 case).CSF protein was 0.39-4.23 g/L, increased in 26 cases, and >1.0 g/L in 11 cases.CSF white blood cell count was 0 ×106 -5 ×106/L in 26 cases, and 6 ×106 -10 ×106/L in 2 cases.Oligoclonal band test of CSF produced positive results in 14 cases, and myelin basic protein was found increased in 18.Anti-GM1 antibodies were positive in 3 cases and anti-GQ1b antibodies in 2 cases.Abnormal CSF cytological results were found in 12 patients , including lymphocytic inflammation in 9 and monocyte-lymphocytic inflammation in 3.The percentage of neutrophils reached 2% in 1 case.Activated lymphocytes were present in 6 cases, activated mononuclear macrophages in 2, and plasma cells in 3.The CSF cell count was over 5/μl in 2 patients (7.1%), significantly lower than the positive rate of CSF cytological test (12 cases, 42.9%, P<0.01).Conclusions CSF cytological test in GBS could detect inflammatory changes such as lymphocyte inflammation , consistent with the pathological mechanism of polyradiculitis in GBS .Compared with CSF routine cell count , cytological test is more sensitive in revealing the inflammatory status of CSF , showing larger diagnostic value for GBS .