54例急性细菌性和隐球菌性脑膜炎实验室指标的比较
注意：本论文已在《中华临床医药杂志（北京）》,2002,3(15): 13-15. 2002年3卷15期13-15页发表
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贺斌 赵忠新 邵福源
第二军医大学附属长征医院神经内科,上海,200003
摘要：目的 研究多项实验室检测指标在急性细菌性和隐球菌性脑膜炎鉴别诊断中的量化标准和意义，并探讨其临床应用价值。方法 对26例急性细菌性和28例隐球菌性脑膜炎病人进行回顾性研究，分别比较其外周血和脑脊液的检测结果。结果 从周围血中性粒细胞百分数、脑脊液糖含量上很难鉴别急性细菌性和隐球菌性脑膜炎。与隐球菌脑膜炎相比，当周围血白细胞总数?2.0?109/L、脑脊液白细胞总数?1000.0?106/L、中性粒细胞数?500.0?106/ L、脑脊液糖?1.7mmol/L、蛋白?2.0g / L、脑脊液糖与血糖比值? 0.35时应高度怀疑细菌性脑膜炎。细菌性脑膜炎脑脊液蛋白增高与血糖水平呈正相关。结论 上述量化标准有助于提高细菌性与隐球菌性脑膜炎鉴别诊断的敏感性和准确性，降低误诊率。
[关键词] 细菌性脑膜炎 隐球菌性脑膜炎 脑脊液 鉴别诊断
Retrospective study of differential diadynamic criteria in 54 patients with acute bacterical and cryptococcal meningitis
He bin，Zhao zhong-xin, Shao fu-yuan. Department of Neurology, Changzheng hospital, Second Military Medical University, Shanghai, 200003.
Abstract: Department of Neurology, Changzheng hospital, Second Military Medical University, Shanghai, 200003
Summary: Objective: To analyze the quantitive standards and sensitivity of multiple laboratory marker in the differential diagnosis of bacterial or cryptococcal meningitis and try to discuss its clinical value. Method: 54 patients with acute bacterial and cryptococcal meningitis were retrospectively analyzed . Peripheral blood picture and laboratory findings of cerebrospianl fluid(CSF) were compared respectively. Result: Acute bacterical meningitis was hardly differentiated from cryptococcal one by peripheral blood polymorphonuclear leukocytes percentage and CSF glucose level. But acute bacterical meningitis should be highly suspected in patients with peripheral WBC count more than 2.0?109/L , more than 1000.0?106/L CSF leukocytes, more than 500.0?106/L CSF polymorphonuclear leukocytes, CSF glucose level less than 1.7mmol/L, a CSF-blood glucose ratio less than 0.35, or a CSF protein level greater than 2.0g/L. The probability of CSF protein elevation in acute bacterial meningitis was positively corrected with blood glucose level. Conclusion: the quantitive standard and main differential points of multiple laboratory marker help to increase the diagnostic accuracy of acute bacterical meningitis from cryptococcal one and decrease the rate of missed diagnosis.
Key word: bacterical meningitis cryptococcal meningitis cerebrospianl fluid diferential diagnosis
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