本文選題：結(jié)核性腦膜炎 + 腦脊液�。� 參考：《中國(guó)神經(jīng)精神疾病雜志》2017年04期

【摘要】：目的探討改良抗酸染色陽(yáng)性結(jié)核性腦膜炎患者的腦脊液特點(diǎn)。方法納入170例臨床診斷為結(jié)核性腦膜炎且改良抗酸染色呈陽(yáng)性患者,收集其一般臨床資料,并對(duì)抗酸染色陽(yáng)性出現(xiàn)時(shí)間、腦脊液細(xì)胞學(xué)分型及抗結(jié)核藥物對(duì)抗酸染色的影響進(jìn)行統(tǒng)計(jì)分析。結(jié)果 128例結(jié)核性腦膜炎患者腦脊液首次抗酸染色陽(yáng)性出現(xiàn)在發(fā)病1個(gè)月內(nèi)(75.3%),其細(xì)胞學(xué)分型包括混雜細(xì)胞反應(yīng)、淋巴細(xì)胞反應(yīng)、嗜中性粒細(xì)胞反應(yīng)、正常細(xì)胞學(xué),分別占15.5%、58.5%、19.5%、6.5%;24例結(jié)核性腦膜炎患者腦脊液首次抗酸染色陽(yáng)性出現(xiàn)在發(fā)病1~2個(gè)月的病例,以上細(xì)胞學(xué)類(lèi)型分別占13.1%、56.5%、21.7%及8.7%;18例結(jié)核性腦膜炎患者腦脊液首次抗酸染色陽(yáng)性出現(xiàn)在發(fā)病2個(gè)月以上的病例,四種細(xì)胞學(xué)分別占26.7%、46.7%、20.0%、6.6%。各種細(xì)胞學(xué)類(lèi)型出現(xiàn)時(shí)間中位數(shù),四組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.812)。應(yīng)用抗結(jié)核藥物的患者其抗酸染色陽(yáng)性中位時(shí)間(據(jù)發(fā)病時(shí)間)21.5(12.3,37.8)d;未應(yīng)用抗結(jié)核藥物者抗酸染色陽(yáng)性中位時(shí)間8.5(6.0,16.3)d,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.001)。應(yīng)用抗結(jié)核藥物的患者抗酸染色轉(zhuǎn)陰中位數(shù)時(shí)間11(5.75,19.25)d;未應(yīng)用抗結(jié)核藥物者抗酸染色轉(zhuǎn)陰中位數(shù)時(shí)間6(4.25,10.75)d,兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.230)。結(jié)論結(jié)核性腦膜炎腦脊液改良抗酸染色首次陽(yáng)性多發(fā)生于發(fā)病1個(gè)月內(nèi),其陽(yáng)性時(shí)的細(xì)胞學(xué)類(lèi)型與抗酸陽(yáng)性時(shí)間無(wú)關(guān),應(yīng)用抗結(jié)核藥物可能會(huì)推遲抗酸桿菌檢出時(shí)間。
[Abstract]:Objective to investigate the cerebrospinal fluid (CSF) features of patients with modified acid-fast positive tuberculous meningitis. Methods 170 patients with tuberculous meningitis and positive for modified acid-fast staining were collected and their general clinical data were collected. The effects of cerebrospinal fluid cytological classification and anti-acid staining of anti-tuberculosis drugs were statistically analyzed. Results in 128 patients with tuberculous meningitis, the first positive reaction of anti-acid staining in cerebrospinal fluid appeared within one month. The cytological types included mixed cell reaction, lymphocyte reaction, neutrophil reaction and normal cytology. The first time acid-fast staining positive in cerebrospinal fluid of 24 patients with tuberculous meningitis occurred within 1 to 2 months after the onset of tuberculous meningitis. The above cytological types accounted for 21. 7% and 8. 7% respectively in 18 patients with tuberculous meningitis who had the first positive acid stain in cerebrospinal fluid for more than 2 months. The four cytology types accounted for 26. 7% and 20. 0% respectively. There was no significant difference between the four groups in the median time of occurrence of various cytological types (P < 0. 812). The median time of positive acid-fast staining in patients with antituberculotic drugs was 21.5 ~ 12.37.8d (according to the onset time), and the median time of anti-tuberculosis drugs was 8.56.0or 16.3drespectively. The difference between the two groups was statistically significant (P 0.001). There was no significant difference between the two groups in the median time of anti-tuberculosis staining to negative in patients with anti-tuberculosis drugs was 115.75 ~ 19.25 days, and that in patients without antituberculous drugs was 64.25 ~ 10.75 days. There was no significant difference between the two groups. Conclusion the first time of modified acid resistance staining in cerebrospinal fluid of tuberculous meningitis occurred within one month, and the cytological type of positive cerebrospinal fluid was not related to the time of acid-fast positive. The detection time of acid-fast bacilli might be delayed by the use of antituberculous drugs.
【作者單位】： 河北醫(yī)科大學(xué)第二醫(yī)院;
【基金】：河北省醫(yī)學(xué)適用技術(shù)跟蹤項(xiàng)目(編號(hào):GL2012026)
【分類(lèi)號(hào)】：R529.3

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