脑脊液细胞学呈混合细胞反应的临床意义

目的探讨脑脊液呈混合细胞反应对结核性脑膜炎的诊断价值及与其它疾病鉴别的临床意义。方法回顾548例不同疾病患者脑脊液细胞学检查结果;采用粟氏细胞分类计数法计数患者不同病程时间的脑脊液细胞,并对其中73例呈混合细胞反应的病例进行统计分析。结果 73例脑脊液呈混合细胞反应的病例中结核性脑膜炎55例,阳性率87.3%（55/63）,病毒性脑膜炎7例,阳性率3.5%（7/202）,隐球菌性脑膜炎3例,阳性率100.0%（3/3）,化脓性脑膜炎2例,阳性率4.8%（2/42）,脑膜癌2例,阳性率8.7%（2/23）,免疫性炎症2例,阳性率2.7%（2/74）,其他疾病2例,阳性1.5%（2/131）。病毒性脑膜炎呈混合细胞反应多在发病3 d以内,最长达7 d;隐球菌性脑膜炎呈混合细胞反应持续时间较长;化脓性脑膜炎在早期呈中性粒细胞反应,在短期治疗后才会出现混合细胞反应;非感染性疾病呈混合细胞反应时细胞数和中性粒细胞比例较少,脑膜癌还可找到恶性细胞。结论脑脊液细胞学呈混合细胞反应多见于结核性脑膜炎,但仍需结合病史、病程作出判断,且脑脊液细胞学动态观察的鉴别意义较大。

The Clinical Significance of Cerebrospinal Fluid Cytology Presenting Mixed Cell Reaction

Objective To explore the diagnostic value of tuberculous meningitis and the clinical signficance of differential diagnosis with other diseases,as cerebrospinal fluid cytology presenting mixed cell reaction.Methods Five hundred and forty eight cases of cerebrospinal fluid cytology were examined using Shu＇s cells differential count method to count the cells in cerebrospinal fluid.Seventy-three cases presenting mixed-cell response in these examinations were analyzed.Results In the 73 cases the percentage of the 55 cases presenting mixed cell reaction in the all tuberculous meningitis cases was 87.3%（55/63 cases）,virus meningitis was 3.5%（7/202 cases）,cryptococcal meningitis was 100.0%（3/3 cases）,purulent meningitis was 4.8%（2/42 cases）,meningeal carcinomatosis was 8.7%（2/23 cases）,immuno-inflammation was 2.7%（2/74 cases）,other diseases was 1.5%（2/131 cases）.Virusmeningitis cases present mixed cell reaction usually in 3 days,at most within 7 days.It is a relatively long duration for the cryptococcal meningitis cases presenting mixed cell reaction.The purulent meningitis cases early present neutrophil reaction.Only aftter short term therapy,did the cerebrospinal fluid cytology present mixed cell reaction.The total number of cells and percentage of neutrophil are small in non-infective diseases.It is possible to find malignant cells in meningeal carcinomatosis cases.Conclusion Cerebrospinal fluid cytology presents mixed cell reaction commonly in tubercular meningitis cases.Still,it is necessary to combined with case history and course of disease in differential diagnosis,and dynamic observing the change of the cytology is more meaning in differential diagnosis.