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目的探讨脑脊液(CSF)细胞学变化对老年结核性脑膜炎(TBM)患者病情评估和临床预后的关系,为老年TBM患者的临床治疗提供参考。方法回顾性研究2010年1月至2015年6月解放军第九七医院神经内科收治的37例老年TBM患者的病例资料,分别采集患者治疗前,治疗7、15、30、60 d的CSF进行常规生化检查和细胞学动态变化检查,并对检查结果进行统计学分析。结果 CSF外观检查有微浑浊、黄色或淡黄色改变22例;蛋白水平升高者34例(0.53~5.33 g/L);葡萄糖水平降低36例(<2.5 mmol/L);氯化物水平降低30例(87~116 mmol/L);34例TBM患者CSF涂片抗酸染色显示阴性反应。嗜中性粒细胞在治疗后7 d开始呈现出明显下降(P<0.05),淋巴细胞、激活淋巴细胞、单核细胞、激活单核细胞及浆细胞比例经治疗后均呈现出不同程度的升高,且与治疗前比较差异均有统计学意义(P<0.05)。细胞反应性诊断结果显示,病程早期以混合性细胞学反应为主,经抗结核治疗后逐步变化为以淋巴细胞学反应为主,治疗后60 d时与治疗前比较差异均具有统计学意义(P<0.05)。结论 CSF细胞学变化检查对老年TBM患者的早期诊断、疾病评估和预后监测具有重要的临床参考价值,值得进一步研究和推广。
Objective To investigate the relationship between cerebrospinal fluid (CSF) cytology and the prognosis of elderly patients with tuberculous meningitis (TBM), and to provide a reference for clinical treatment of elderly patients with TBM. Methods The clinical data of 37 elderly TBM patients admitted to the Department of Neurology, the 97th Hospital of PLA from January 2010 to June 2015 were retrospectively studied. Before treatment, patients were treated with CSF at 7, 15, 30 and 60 days respectively for routine Biochemical tests and cytology dynamic examination, and the results of the test for statistical analysis. Results There were 22 cases of micro-turbidity and yellow or light-yellow change in CSF appearance, 34 cases (0.53-5.33 g / L) of elevated protein level, 36 cases (<2.5 mmol / L) Cases (87 ~ 116 mmol / L); 34 cases of TBM CSF smear acid-fast staining showed negative. Neutrophils began to show a significant decrease on the 7th day after treatment (P <0.05). The proportion of lymphocytes, activated lymphocytes, monocytes, activated monocytes and plasma cells showed different degrees of increase after treatment High, and compared with before treatment were statistically significant (P <0.05). The results of the cellular reactivity diagnosis showed that the early course of the disease was mainly mixed cytology and gradually changed to the lymphocytic reaction after the anti-TB treatment. The difference was statistically significant at 60 days after treatment and before treatment P <0.05). Conclusion The CSF cytology test has important clinical reference value for the early diagnosis, disease evaluation and prognosis monitoring of elderly patients with TBM. It is worth further study and promotion.