摘要
目的 分析脑脊液细胞学在3~6岁结核性脑膜炎(TBM)患儿病程中的表达情况及临床意义。方法 选取108例3~6岁TBM患儿纳入观察组;另选取同期非结核性脑膜炎患儿(化脓性、病毒性脑膜炎)108例纳入对照组。采集两组的脑脊液标本,开展脑脊液细胞学检查和常规、生化检查,分析脑脊液细胞学在诊断TBM中的作用与价值。结果 与对照组各亚组相比,观察组有着更高的蛋白定量、白细胞数、腰穿压力与淋巴细胞数(P<0.05)及更低的氯化物、葡萄糖水平(P<0.05)。在观察组的脑脊液细胞学结果中,多为混合细胞反应,对照组病毒性、化脓性脑膜炎分别为淋巴细胞反应、多形粒细胞反应居多。病程≤2周的TBM患儿有着最高的嗜中性粒细胞、单核细胞占比和白细胞计数,且均较病程为3~4周、>4周患儿高(P<0.05);病程3~4周患儿以上指标都有下降,淋巴细胞比例有明显升高;病程>4周者的淋巴细胞呈下降趋势,且相比3~4周者,有着更低的白细胞计数及嗜中性粒细胞、单核细胞、淋巴细胞水平(P<0.05)。结论 3~6岁TBM患儿前2周白细胞数与嗜中性粒细胞、单核细胞比例较高,持续2周后,淋巴细胞比例升高,其他指标下降;而在4周后,指标均下降。在诊断TBM中,脑脊液细胞学混合型反应准确率理想,适用于此病的早期诊断。
Objective To analyze the expression and clinical significance of cerebrospinal fluid(CSF)cytology in the disease course of tuberculous meningitis(TBM)in children aged 3 to 6 years.Methods A total of 108 children aged 3-6 years with TBM were enrolled as the observation group,and 108 children with non-tuberculous meningitis(pyogenic or viral meningitis)were enrolled as the control group.CSF samples from both groups were collected for CSF cytology,routine,and biochemical examinations.The role and value of CSF cytology in diagnosing TBM were analyzed.Results Compared with each subgroup of the control group,the observation group exhibited higher protein quantification,white blood cell count,lumbar puncture pressure,and lymphocyte count(P<0.05),along with lower chloride and glucose levels(P<0.05).In the cerebrospinal fluid(CSF)cytology results of the observation group,mixed cellular reactions were predominant,whereas in the control group,viral and purulent meningitis cases predominantly showed lymphocyte reactions and polymorphonuclear leukocyte reactions,respectively.TBM children in the early stage of the disease(within the first 2 weeks)had the highest proportions of neutrophils and monocytes,as well as the highest white blood cell count,all of which were significantly higher than those in children with a disease duration of 3 to 4 weeks or exceeding 4 weeks(P<0.05).In children with a disease duration of 3 to 4 weeks,all the aforementioned indicators decreased,with a notable increase in the lymphocyte proportion.Children with a disease duration exceeding 4 weeks showed a declining trend in lymphocytes and had lower white blood cell counts,as well as lower levels of neutrophils,monocytes,and lymphocytes compared to those with a disease duration of 3 to 4 weeks(P<0.05).Conclusion Among children aged 3 to 6 years with TBM,WBC count and the proportions of neutrophils and monocytes are elevated during the first two weeks.After two weeks,lymphocyte proportion increases while other indices decline.By four weeks,all indices show a decreasing trend.CSF cytology demonstrating a mixed cell reaction provides high diagnostic accuracy and is suitable for the early diagnosis of TBM.
作者
王丽苹
王云霞
白明彦
Wang Liping;Wang Yunxia;Bai Mingyan(Department of Clinical Laboratory,Xinzheng Public People's Hospital,Xinzheng 451100,Henan,China)
关键词
结核
脑膜炎
脑脊液
细胞学计数
Tuberculosis
Meningitis
Cerebrospinal fluid
Cytological count
