【摘要】 目的比较分析多项实验室检测指标对早期化脓性与病毒性脑膜炎诊断的敏感性及量化标准,并探讨其鉴别诊断价值。方法收集发病3d内就诊的55例脑膜炎患者的外周血像、血糖及C-反应蛋白(CRP),脑脊液(CSF)白细胞数、蛋白、糖及CRP的检测结果。其中经病原学及/或临床治疗确诊的化脓性脑膜炎25例、病毒性脑膜炎30例,对其实验室结果进行比较研究。结果外周血像、CSF白细胞总数和中性粒细胞数在早期两种脑膜炎互有重叠,鉴别化脓性或病毒性脑膜炎存在一定困难。而采用CSF蛋白>1.5g/L,血清CRP>16mg/L,CSF糖与血糖比值≤0.35等量化指标,则明显提高化脓性脑膜炎的早期诊断价值。如果对这些指标进行组合,可进一步增加鉴别两种脑膜炎的敏感性。结论选择CSF糖与血糖比值、血清CRP、CSF蛋白等实验室指标并设定量化标准,或者对这些指标进行组合检测,可提高鉴别诊断早期化脓性与病毒性脑膜炎的敏感性和准确性,有利于减少误诊,增强治疗的针对性。更多还原

【Abstract】 Objective To study the early purulent meningitis (PM) and viral meningitis (VM) through the quantitative analysis of various laboratory tests. Method 55 patients with an onset of meningitis within 3 days were analyzed for the white cell population , glucose and C-reactive protein (CRP) from their cerebrospinal fluid (CSF) and serum. 25 cases of PM and 30 cases of VM were confirmed through microbiological analysis and clinical study. Result In the early diagnosis, the number of leukocytes and neutrophilic granulocytes in blood and CSF was similar in the PM and VM patients. The values of these laboratory parameters were increased when the following parameters were adopted: protein level in CSF > 1.5 g/L, serum CRP level >16 mg/L, ratio of glucose in CSF and serum ≤0.35. The accuracy of diagnosis of PM and VM was increased if all of these data were taken into consideration. Conclusion Combination of these laboratory parameters, such as the ratio of glucose in CSF and serum, serum CRP, and proteins in CSF, would increase the accuracy of labortory disagnosis of early PM and VM. It will also reduce the chance of misdiagnosis.更多还原