Clinical Study Of Dynamic Cerebrospinal Fluid Cytology In Drug Resistant Tuberculous Meningitis

Objective:To analyze the clinical manifestations and cerebrospinal fluid cytological characteristics of drug-resistant tuberculous meningitis(TBM),and to explore the value of dynamic changes of cerebrospinal fluid(CSF)cytology in drug resistance and efficacy evaluation of TBM.Methods:The clinical symptoms,routine biochemistry and dynamic changes of cytology of CSF and the outcome of the disease were observed in 37 cases of drug resistant and compared with 42 cases of first-line drug sensitive TBM patients which were confirmed by CSF test.Results:There was no significant difference in clinical manifestations and CSF routine,biochemical and cytological classification between drug-resistant group and non drug resistant group(P>0.05).Of the 37 drug-resistant TBM,33 cases of CSF nucleated cell count did not decrease significantly,showing prolonged inflammatory reaction of CSF mixed cells lasting more than four weeks,and 4 cases of CSF improved within four weeks were single drug resistant.In 33 drug-resistant patients,even after changing the treatment plan according to the results of drug sensitivity,only 9 cases of CSF cytology transformed into significant lymphocyte reaction within four weeks.The total number of CSF cells decreased significantly within four weeks after treatment,and the CSF cytology transformed into lymphocyte reaction significantly of 38 cases in the control group.There were statistically significant differences in the number of nucleated cells(χ~2=5.05,P<0.05 andχ~2=11.10,P<0.05)and the proportion of cell transformation(χ~2=13.76,P<0.05 andχ~2=4.75,P<0.05)in CSF between the two groups after the second and fourth weeks of treatment.All patients were followed up for 6 months,16 cases were effective,19 cases were ineffective(17cases died,of these,16 cases were MDR-TBM),2 cases did not complete the follow-up,total effective rate 43.2%.Of 42 cases in the control group,36 cases were effective,4 cases were ineffective(3 cases died),2 cases did not complete the follow-up,total effective rate 85.7%.The transformation degree of CSF cytology to significant lymphocyte reaction was positively correlated with the improvement of clinical symptoms.Conclusion:The cytological characteristics of CSF in patients with tuberculous encephalopathy are mainly characterized by mixed cell inflammatory reaction.The delayed inflammatory reaction of CSF mixed cells lasting more than four weeks during the treatment may be the cytological manifestation of CSF in patients with drug-resistant TBM,which is the basis for indicating that the treatment plan is invalid.In clinic,due to the limitation of drug resistance detection time and conditions,dynamic CSF cytology monitoring may be a valuable auxiliary means to evaluate the drug resistance of TBM,which can provide reference for clinical efficacy evaluation.