目的探讨动态观察脑脊液细胞 学及生化指标结合MRI影像学诊断结核性 脑膜炎的价值。方法 回顾性分析我院 2013年1月-2017年1月收治的110例TBM患 者临床资料。所有患者接受动态观察脑 脊液细胞学、生化指标检查、头部MRI检 查，并接受治疗。结果 TBM患者颅内压、 白细胞计数、中性粒细胞计数、淋巴细胞 计数、单核细胞水平显著低于初次检查 (P<0.05)。脑脊液蛋白、葡萄糖、脑脊液 腺苷脱氨酶水平低于初次检查，氯化物 水平高于初次检查(P<0.05)。38例平扫显 示脑膜增厚。105例脑膜病灶分布在基底 池，5例脑膜病灶分布在侧裂池。81例患 者出现多栗样病灶。脑实质多栗样病灶 平扫T1WI呈等信号，T2WI呈低信号，直径 >5mm栗样病灶伴灶周水肿，增强扫描发现 小结节状强化。伴脑内结核性脓肿，T1WI 低信号、T2WI高信号，增强扫描见环状强 化。伴脑梗死患者为腔隙性梗死，病灶分 布于基底节区。并发脑积水患者脑室系统 扩张，以侧脑室最明显。80.91%痊愈、 19.09%无效、3.64%死亡。结论 结核性脑 膜炎患者颅内压、白细胞计数、中粒细胞 计数、淋巴细胞计数水平、脑脊液蛋白、 葡萄糖、脑脊液腺苷脱氨酶水平升高。 MRI呈脑实质多栗样病灶、脑膜增厚，增 强扫描发现小结节状强化。

Objective To investigate the dynamic observation of cytology and biochemical markers in cerebrospinal fluid combined with the MRI in the diagnosis of tubercular meningitis (TBM). Methods The clinical data of 110 patients with TBM admitted to our hospital from January 2013 to January 2017 were retrospectively analyzed. All patients received the dynamic observation of cytology and biochemical markers in cerebrospinal fluid, head MRI, and symptomatic treatment. Results The intracranial pressure, white blood cell count, myelocyte count, lymphocyte count, monocyte level of the secondary examination were significantly lower than those in the initial examination (P<0.05). The levels of cerebrospinal fluid protein, glucose, and cerebrospinal fluid adenosine deaminase were lower than those of the initial examination, while the chloride level was higher in the secondary examination (P<0.05). Thickening meningeal lesions was found in 38 cases; Lesions located in basal cisterns and lateral fissure pools were found in 105 and 5 cases, respectively. 81 patients had multiple chestnut-like lesions. The lesions presented isointense signal in T1WI and hypointense signal in T2WI. The lesions with diameter >5mm had perifocal edema and had tiny nodular enhancement after contrast administration. The intracerebral tuberculous abscess with hypointense signal in T1WI and hyperintense signal in T2WI. The lesions had ring-like enhancement after contrast injection with obvious edema. For cerebral infarction, the lacunar infarcts with lesions were distributed in the basal ganglia region. The image of hydrocephalus showed a dilated ventricular system with the most pronounced lateral ventricles. 80.91%were cured, 19.09% were invalid including 3.64% died. Conclusion The intracranial pressure, white blood cell count, myelocyte count, lymphocyte count, cerebrospinal fluid protein, glucose, and cerebrospinal fluid adenosine deaminase levels are elevated in patients with tuberculous meningitis. MRI shows a chestnut-like lesion in the brain parenchyma and thickening meningeal, and tiny nodular enhancement after contrast administration.