von Herbay A, Ditton H J, Schuhmacher F, Maiwald M
Institute of Pathology, University of Heidelberg, Germany.
Gastroenterology. 1997 Aug;113(2):434-41. doi: 10.1053/gast.1997.v113.pm9247461.
BACKGROUND & AIMS: Diagnostic procedures in Whipple's disease usually focus on the intestine, but symptomatic central nervous system involvement is a major threat for patients. The aim of this study was to determine the diagnostic value of cerebrospinal fluid (CSF) analysis.
A total of 39 CSF samples and 2 brain biopsy specimens that were obtained from 24 patients with Whipple's disease at various intervals after diagnosis were examined. Five patients presented with neurological symptoms, 3 of them as relapses after therapy. Thirty-two CSF samples were examined by polymerase chain reaction for Tropheryma whippelli and 20 CSF samples by cytology. Brain biopsy specimens were examined histologically.
Positive results were obtained in 4 of 5 patients (80%) with neurological symptoms, in 7 of 10 patients (70%) without neurological symptoms examined before therapy, and in 3 of 11 patients (27%) without neurological symptoms studied during or after therapy. Conversion from positive to negative was observed in 4 patients after antibiotic treatment.
Testing of CSF in Whipple's disease yields a high rate of positive results, even in patients without neurological symptoms. Examination of CSF is therefore potentially useful for initial staging and for monitoring of the efficiency of therapy.
惠普尔病的诊断程序通常聚焦于肠道，但有症状的中枢神经系统受累对患者来说是一个重大威胁。本研究的目的是确定脑脊液（CSF）分析的诊断价值。
对从24例惠普尔病患者诊断后的不同时间点获取的39份脑脊液样本和2份脑活检标本进行检查。5例患者出现神经症状，其中3例为治疗后复发。对32份脑脊液样本进行了针对惠普尔嗜组织细胞菌的聚合酶链反应检测，对20份脑脊液样本进行了细胞学检查。对脑活检标本进行了组织学检查。
5例有神经症状的患者中有4例（80%）检测结果呈阳性，10例治疗前无神经症状的患者中有7例（70%）检测结果呈阳性，11例治疗期间或治疗后无神经症状的患者中有3例（27%）检测结果呈阳性。4例患者在抗生素治疗后检测结果从阳性转为阴性。
即使在无神经症状的患者中，惠普尔病脑脊液检测的阳性率也很高。因此，脑脊液检查对于疾病的初始分期和治疗效果监测可能有用。
