作者：张萍淑1，2 ，陶莉 1，2 ，刘妍 1 ，吴小英 1，2 ，张健 1，2 ，乔思佳 1 ，李佳慧 1 ，郑慧 1 ，元小冬 1，2

单位：

1.063000 河北省唐山市，开滦总医院神经内科　；2.063000 河北省唐山市，河北省神经生物机能重点实验室；通信作者：元小冬，E-mail：yxd69@sohu.com

关键词：

病毒性脑炎；边缘性脑炎；脑脊液；诊断，鉴别；对比研究

Keywords：

Viral encephalitis；Marginal encephalitis；Cerebrospinal fluid；Diagnosis，differential；Comparative study

CLC：

R 512.31　R 512.3

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.011

Funds：

2018 年唐山市科学技术研究与发展计划项目（18130202B）

摘要：

目的　对比分析病毒性脑炎与边缘性脑炎的脑脊液病理学特征。方法　选取 2014—2018 年在开滦总医院神经内科确诊的病毒性脑炎患者 166 例作为 A 组，边缘性脑炎患者 38 例作为 B 组；另选取同期在本院因外科手术需行蛛网膜下腔阻滞麻醉者 30 例作为对照组。比较 A 组和 B 组患者神经功能损伤程度、临床症状和体征及脑脊液寡克隆区带阳性率，并比较三组患者脑脊液生化指标（包括葡萄糖、氯化物及蛋白质）和细胞学检查结果（包括白细胞计数及淋巴细胞比例、单核细胞比例、激活的单核细胞比例、中性粒细胞比例、嗜酸粒细胞比例、嗜碱粒细胞比例、浆细胞比例）。结果　（1）A 组和 B 组患者神经功能损伤程度比较，差异无统计学意义（P>0.05）。（2）A 组和 B组患者发热、意识障碍、近事记忆减退发生率比较，差异无统计学意义（P>0.05）；B 组患者抽搐 / 癫痫发作、精神行为异常发生率高于 A 组，脑膜刺激征阳性、病理征阳性者所占比例低于 A 组（P<0.05）。（3）三组患者脑脊液氯化物含量比较，差异无统计学意义（P>0.05）；A 组患者脑脊液葡萄糖含量低于 B 组，脑脊液蛋白质含量高于对照组和 B 组，潘氏试验结果劣于对照组和 B 组（P<0.05）。（4）三组患者脑脊液单核细胞比例、嗜酸粒细胞比例、嗜碱粒细胞比例、浆细胞比例比较，差异无统计学意义（P>0.05）；A 组患者脑脊液白细胞计数、淋巴细胞比例及激活的单核细胞比例高于对照组和 B 组（P<0.05）；B 组患者脑脊液白细胞计数、淋巴细胞比例、中性粒细胞比例高于对照组（P<0.05）。（5）A 组患者脑脊液寡克隆区带阳性率高于 B 组（P<0.05）。结论　病毒性脑炎患者脑脊液蛋白质含量、白细胞计数、淋巴细胞比例、激活的单核细胞比例及免疫球蛋白含量明显升高，脑脊液葡萄糖含量降低，而边缘性脑炎患者脑脊液白细胞计数、淋巴细胞比例轻微升高但中性粒细胞比例明显升高，脑脊液病理学特征对病毒性脑炎与边缘性脑炎具有一定鉴别诊断价值。

Abstract：

Objective　To contrastively analyze the pathological features of cerebrospinal fluid（CSF）betweenviral encephalitis and marginal encephalitis. Methods　From 2014 to 2018，a total of 166 patients with viral encephalitis wereselected as A group and 38 patients with marginal encephalitis as B group in the Department of Neurology，Kailuan GeneralHospital，meanwhile 30 volunteers who underwent subarachnoid block anesthesia for surgery were selected as control group.Degree of neurological damage，clinical symptoms and signs，positive rate of CSF oligoclonal bands were compared between Agroup and B group，moreover biochemical indicators（including glucose，chloride and protein） and cytological examinationresults（including leukocyte count，lymphocyte ratio，monocyte ratio，activated monocyte ratio，neutrophil ratio，eosinophilratio，basophil ratio and plasma cell ratio）of CSF were compared in the three groups. Results　（1）There was no statisticallysignificant difference in degree of neurological damage between A group and B group（P>0.05）.（2）There was no statisticallysignificant difference in incidence of fever，disturbance of consciousness or recent memory impairment between A group andB group（P>0.05）；incidence of convulsion/epileptic seizure，mental and behavior disorder in B group was statisticallysignificantly higher than that in A group，respectively，while proportion of patients with positive meningeal irritation sign andpathological sign in B group was statistically significantly lower than that in A group，respectively（P<0.05）. （3）Therewas no statistically significant difference in chloride content of CSF in the three groups（P>0.05）；glucose content of CSFin A group was statistically significantly lower than that in B group，while protein content of CSF in A group was statisticallysignificantly higher than that in control group and B group，respectively，moreover Pan's test result in A group was statisticallysignificantly worse than in control group and B group，respectively（P<0.05）.（4）There was no statistically significantdifference in monocyte ratio，eosinophil ratio，basophil ratio or plasma cell ratio of CSF in the three groups（P>0.05）；leukocyte count，lymphocyte ratio and activated monocyte ratio of CSF in A group were statistically significantly higher thanthose in control group and B group，moreover leukocyte count，lymphocyte ratio and neutrophil ratio of CSF in B group werestatistically significantly higher than those in control group（P<0.05）.（5）Positive rate of CSF oligoclonal bands in Agroup was statistically significantly higher than that in B group（P<0.05）. Conclusion　Protein content，leukocyte count，lymphocyte ratio，activated monocyte ratio and immunoglobulin content of CSF significantly increase but glucose content of CSFsignificantly reduces in patients with viral encephalitis，leukocyte count as well as lymphocyte ratio of CSF slightly increaseand neutrophil ratio of CSF significantly increases in patients with marginal encephalitis，thus pathological features of CSF havedifferential diagnostic value between viral encephalitis and marginal encephalitis to some extent.

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