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目的 分析脑脊液 (CSF)免疫球蛋白 (Ig)和白蛋白 (Alb)对病毒性脑膜炎 (VM )、结核性脑膜炎 (TM )、化脓性脑膜炎(PM )的鉴别诊断意义。方法 用速率散射比浊法测定VM 5 3例 ,TM 40例 ,PM 14例患者CSFIg和Alb的含量。结果 IgG、IgM和Alb在TM和PM中均显著高于VM组 (P <0 0 0 1) ,且以PM升高最明显 ,但TM和PM间 ,Alb及比值变化无显著性意义 ;与VM相比 ,TM以IgG变化最突出 ( 75 %) ,PM以IgM变化为显著 ( 78%) ;Alb在TM和PM升高比例最高 ( 10 0 %)。PM 14例中有 12例 ( 85 .7%)、TM 40例中仅 6例 ( 15 %)符合典型CSF常规和生化改变。如果把CSFAlb >3 0 0mg/L和IgG >61mg/L作为条件 ,则TM的诊断阳性率达 3 8/ 40 ( 95 %)。结论 TM和PM血脑屏障的破坏明显大于VM ,CSFIg和Alb的含量检测弥补了CSF常规分析的不足 ,有助于颅内感染的诊断和鉴别诊断
Objective To analyze the differential diagnostic significance of cerebrospinal fluid (CSF) immunoglobulin (Ig) and albumin (Alb) on viral meningitis (VM), tuberculous meningitis (TM) and purulent meningitis (PM). Methods The contents of CSFIg and Alb in VM 5 3 cases, TM 40 cases and PM 14 cases were determined by rate nephelometry. Results IgG, IgM and Alb in TM and PM were significantly higher than those in VM (P <0.01 01), and the most significant increase was in PM, but there was no significant difference in Alb and ratio between TM and PM; Compared with VM, TM showed the highest IgG (75%) and the PM (IgM) significantly (78%). Alb showed the highest proportion of TM and PM (100%). Of the 14 PM patients, 12 (85.7%) had TM and only 6 (15%) of 40 TM patients met the typical CSF biochemical and biochemical changes. If the CSFAlb> 300mg / L and IgG> 61mg / L as a condition, then the diagnosis of TM positive rate of 38/40 (95%). Conclusion The damage of TM and PM blood-brain barrier is obviously greater than that of VM. The detection of CSFIg and Alb can make up for the deficiencies of routine analysis of CSF and contribute to the diagnosis and differential diagnosis of intracranial infection