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许多神经系统疾病都需要通过脑脊液(CSF)检查来确诊或排除相关的鉴别诊断。本文的目的是评价CSF常规检查的理论背景并为其临床应用提供指南,包括总蛋白、白蛋白、免疫球蛋白、葡萄糖、乳酸盐、细胞计数、细胞染色和感染性CSF的检查。研究方法包括对上述指标的系统Medline检索以及由一位或多位特别工作组成员对相关文献进行评价。在特别工作组全体成员共识基础上对证据和推荐意见进行分级。建议CSF应在采集后立即送检。如果需要贮存,应将12 mL CSF分装3～4只无菌试管。推荐测定CSF/血清白蛋白比率(Q_(alb))而不是总蛋白水平,其正常上限应与患者年龄相关。Q_(alb)升高是一种非特异性表现,但主要见于细菌性、隐球菌性和结核性脑膜炎、软脑膜转移瘤以及急性和慢性脱髓鞘性多发性神经病。CSF/血清葡萄糖比率的病理性下降或乳酸盐浓度升高提示细菌或真菌性脑膜炎或软脑膜转移瘤。通过在等电聚焦电泳后进行特殊染色可完美证实鞘内免疫球蛋白G合成。只要发现脑脊液细胞增多或怀疑软脑膜转移瘤或病理性出血,就应进行细胞形态学(细胞染色)评价。对于CT扫描结果阴性的鞘内出血,应进行胆红素检测。
Many neurological diseases require CSF confirmation to diagnose or exclude related differential diagnosis. The purpose of this paper is to evaluate the theoretical background of routine CSF examination and to provide guidelines for its clinical application including examination of total protein, albumin, immunoglobulins, glucose, lactate, cell counts, cell staining and infectious CSF. Research methods include a systematic Medline search of these indicators and the evaluation of relevant literature by one or more members of the task force. Evidence and recommendations are rated on the basis of consensus of all members of the Task Force. It is recommended that CSF should be inspected immediately after collection. If storage is required, 3-4 mL of sterile tubes should be dispensed in 12 mL of CSF. It is recommended to determine the CSF / serum albumin ratio (Q alb) rather than the total protein level, and its normal upper limit should be age dependent. Elevated Q alb is a nonspecific manifestation but is mainly found in bacterial, cryptococcal and tuberculous meningitis, leptomeningeal metastases, and acute and chronic demyelinating polyneuropathies. Pathological decline in the CSF / serum glucose ratio or elevated lactate concentration suggests bacterial or fungal meningitis or leptomeningeal metastases. Intranasal immunoglobulin G synthesis is perfectly demonstrated by special staining after isoelectric focusing. As long as the discovery of cerebrospinal fluid cells or suspected leptomeningeal metastasis or pathological bleeding, cell morphology should be carried out (cell staining) evaluation. For intrathecal hemorrhage negative for CT scans, bilirubin testing should be performed.