急性脑膜炎的鉴别诊断-神经病学专业论文.docxVIP

第一部分57例急性细菌性和病毒性脑膜炎鉴别诊断指标的回顾性研究 第一部分 57例急性细菌性和病毒性脑膜炎鉴别诊断指标的回顾性研究 Retrospective study of differential diadynamic criteria in 57 patients with acute bacterical and viral meningitis 摘 摘 要 日的研究多项实验室检测指标在急性细菌性和病毒性脑膜炎鉴别诊 断中的敏感性及量化标准，并探讨其临床应用价值。方法对26例 急性细菌性和31例病毒性脑膜炎病人进行回顾性研究，分别比较其 临床症状、外周血和脑脊液的检测结果。结果从临床症状和外周血 像上很难鉴别急性细菌性和病毒性脑膜炎。但当脑脊液的糖 1．7mmol／L、脑脊液白细胞总数2000x106／L、中性粒细胞数 1000x106／L、蛋白2．Og／L、脑脊液糖与血糖比值0．35时应高度 怀疑细菌性脑膜炎。上述指标鉴别两者的敏感性依序为：脑脊液糖 与血糖比值、脑脊液糖、蛋白和脑脊液中性粒细胞数、脑脊液白细 胞总数。结论：上述量化标准有助于提高细菌性与病毒性脑膜炎鉴 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 病毒性脑膜炎 脑脊液鉴别诊断 Abstract0bjective Abstract 0bjective To analyze the quantitive standards and sensitivity of multiple laboratory marker in the differential diagnosis of bacterial or viral meningitis and try to discuss its clinical value．Method 57 patients with acute bacterial and viral meningitis were retrospectively analyzed． Clinical symptoms and peripheral blood picture as well as laboratory findings of cerebrospianl fluid(CSF)were compared respectively．Result Acute bacterical meningitis was hardly differentiated from acute viral one by clinical symptoms and peripheral blood picture．But acute bacterical meningitis should be highly suspected in patients with a CSF glucose level less than 1．7mmol／L，a CSF-blood glucose ratio less than 0．35，a CSF protein level greater than 2．0叽more than 2000．0x106／t CSF leukocytes， or more than 1000．0×106／L CSF polymorphonuclear leukocytes．The sensitivity of the subsequence of the laboratory markers were as follows：CSF-blood glucose ratio，CSF glucose level，CSF protein level and CSF polymorphonuclear leukocytes，CSF leukocytes． Conclusion the quantitive standard and main differential points of multiple laboratory marker help to increase the diagnostic accuracy of acute bacterical meningitis and decrease the rate of misdiagnosis． Key word：bacterical meningitis； viral meningitis； cerebrospianl fluid； diferential diagnosis 急性细菌性脑膜炎(以下简称细脑)临床主要表现为头痛、发 急性细菌性脑膜炎(以下简称细脑)临床主要表现为头痛、发 热、恶心、呕吐、颈项强直等，临床诊断并不难，但早期临床表现 很难与病毒性脑膜炎(以