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ע⣺ՓڡȾs־2002,Vol.2,No.3:111-114,160l
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Dynamic study of cerebral spinal fluid marker in 57 patients with cryptococcal and tuberculous meningitis


He binZhao zhong-xin, Shao fu-yuan. Department of Neurology, Changzheng hospital, Second Military Medical University, Shanghai, 200003.

Abstract: Objective: To study the main differential points between the cryptococcal and tuberculous meningitis by means of dynamic comparision of the multiple cerebrospinal fluid(CSF) markers. Method: 57 patients with the cryptococcal and tuberculous meningitis were analyzed retrospectively. The dynamic changes of the laboratory findings of CSF were compared within 3 weeks in 57 patients after admission. The logistic regression method was employed to analyze effecting factors of the significant elevation of the CSF proteins level(?1g/L) in patients with cryptococcal meningitis in the first week after admission. Result: in the first week after admission, no statistical significance was found among the total CSF WBC counts, the CSF neutrophile percentage , the CSF lymphocyte percentage, the CSF RBC counts , or the CSF glucose level in cryptococcal meningitis as compared to those in tuberculous one. The CSF chloride level was higher in cryptococcal meningitis than that in tuberculous one. By contrast, the CSF protein level was higher in the latter than that in the former. The dynamic comparasive results of the multiple CSF markers between the two groups within 3 weeks after admission were as follows: (1) The total CSF WBC counts, the CSF RBC counts, or the CSF neutrophile percentage in cryptococcal meningitis were decreasing continuously after antifungal therapy while the CSF lymphocyte percentage showed no change statistically. There was none change among those CSF cellular markers mentioned above in tuberculous meningitis in the same time after the anti-tubercle therapy. (2) Neither the CSF chloride nor the CSF glucose level was elevated significantly in cryptococcal meningitis while the CSF protein level increased continuously. (3) No significant change was noticed in either the CSF protein or the CSF glucose level in tuberculous meningitis although the CSF chloride level decreased continuously. The lymphocye percentag and the patient's age were found in correlation with the significant elevation of the CSF protein level(?1g/L) in patients with cryptococcal meningitis within the first week after admission. Conclusion: As compared to cryptococcal meningitis, tuberculous meningitis should be highly suspected if the CSF protein level was more than ?1g/L within the first week after admission, or the CSF chloride level decreased continuously within 3 weeks after admission. By contrast to tuberculous meningitis, cryptococcal meningitis should be highly suspected if the CSF protein level increased continuously within 3 weeks after admission.
Key word: tuberculous meningitis cytpcoccal meningitis cerebrospianl fluid diferential diagnosis

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