Dynamic changes of cerebrospinal fluid cytology in the course of tuberculous meningitis and its diagnostic value / 中国医师杂志

ABSTRACT

Objective To investigate the dynamic changes of cerebrospinal fluid (CSF) cytology in the course of tuberculous meningitis (TBM) and its diagnostic value.Methods 37 children with TBM who were treated in the department during January 2008 to December 2016 were selected as the observation group.Another 40 children with non-TBM (including viral encephalitis and suppurative encephalitis) were selected as the control group at the same time.The CSF samples were collected for routine,biochemical and CSF cytological examinations.The detection of mycobacterium tuberculosis antigen pure protein derivative (PPD) positive cell rate (monocyte) was performed,and the value of CSF cytology in the diagnosis of TBM was summarized.Results (1) The lumbar puncture pressure,white blood cell count,lymphocyte count and protein quantification in the observation group were higher than those in subgroups of the control group,while the glucose and chloride levels were lower than those in the subgroups (P ＜ 0.05).(2) The cytological examination of CSF in the observation group mainly was mixed cell reaction,accounting for 83.78％,followed by lymphocyte reaction (10.81％).Viral meningitis mainly manifested as lymphocyte reaction,accounting for 82.14％,while suppurative meningitis mainly manifested as polymorphonnclear response,accounting for 75.00％.(3) The positive rate of PPD antigen in the observation group was 81.08％,which was significantly higher than that in children with viral meningitis,suppurative meningitis (P ＜ 0.05).(4) The accuracy rate of protein level ＞0.45 g/L in the diagnosis of TBM was 89.19％,and the accuracy rate of CSF cytological mixed cell response was 83.78％.(5) The white blood cell count,the proportion of monocytes and the proportion of neutrophils were the highest in children with tuberculous meningitis less than 2 weeks,compared with those in children with 3-4 weeks and ＞4 weeks (P ＜0.05).The above-mentioned cytological indexes were decreased while the proportion of lymphocytes was increased in children with TBM whose course of disease was 3-4 weeks.The white cell count,proportions of monocytes,lymphocytes and proportion of neutrophils in children whose course of disease was longer than 4 weeks were lower than those in children whose course of disease was 3-4 weeks (P ＜ 0.05).Conclusions The white blood cell count,proportion of monocyte and proportion of neutrophils were relatively higher in the first 2 weeks of TBM,and maintained for 2 weeks.2 weeks later,levels of above-mentioned cells decreased except for lymphocytes while the proportion of lymphocytes increased continuously and then decreased gradually 4 weeks later.The diagnostic accuracy rate of CSF cytological mixed reaction to TBM was relatively higher,and the consistency with tuberculosis antigen PPD examination was high,which could be used as a choice for early diagnosis of TBM.