脑脊髓液中腺苷脱氨酶活性对结核性脑膜炎诊断价值的临床研究

目的 探讨脑脊髓液中腺苷脱氨酶（CSF-ADA）活性对结核性脑膜炎的诊断价值及在病程中的动态变化.方法 选择160例患者纳入本研究,76例结核性脑膜炎为病例组;84例非结核性脑膜炎为对照组,其中细菌性脑膜炎36例,病毒性脑膜炎30例,隐球菌性脑膜炎18例.每例患者均于治疗前抽取CSF,采用酶耦联Trinder法测定CSF-ADA活性,结果以（-x）±s表示,组间差异使用Mann-Whitney U检验.47例结核性脑膜炎患者于抗结核治疗后2周和6周时再次检测CSF-ADA,治疗前后差异使用配对t检验.结果 结核性脑膜炎组CSF-ADA活性为（12.9±6.4）U/L,非结核性脑膜炎组为（6.0±4.1）U/L,两组比较差异有统计学意义（U=7.860,P＜0.05）.取CSF-ADA≥9 U/L作为临界值时鉴别结核性脑膜炎与非结核性脑膜炎价值最高,灵敏度为84.21%,特异度为83.33%.随着患者病情好转,CSF-ADA活性逐渐降低.结论 CSF-ADA活性≥9 U/L可作为诊断结核性脑膜炎的一项辅助诊断指标,抗结核治疗后CSF-ADA活性可作为疗效判断的参考指标.

Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis

Objective To evaluate cerebrospinal fluid adenosine deaminase（CSF-ADA）activity in the diagnosis of tuberculous meningitis（TMB）, and to observe its dynamic changes. Methods A total of 160 patients were included and were divided into two groups： 76 cases of TBM and 84 cases of non-TBM.Among the cases of non-TBM, there were 36 cases of bacterial meningitis, 30 cases of viral meningitis and 18 cases of cryptocoocal meningitis. All the patients were measured with their CSF-ADA activity by Enzymecoupled assay（Trinder method）and 47 patients of TBM were measured again after 2 weeks＇ and 6 weeks＇antitubercular therapy. Results were expressed as（-x）± s. Mann-Whitney U test and paired-samples t test were used. Results CSF-ADA activity in TBM group was（12.9 ±6.4）U/L, while that in the non-TBM group was（6.0 ± 4.1）U/L, the difference was of statistical significance（U = 7.860, P 〈 0.05）. With the cutoff value of 9 U/L, the sensitivity and specificity to differentiate TBM from non-TBM was 84.21% and 83. 33%, respectively. CSF-ADA activity decreased in TBM patients after antitubercular treatment.Conclusions CSF-ADA activity can be an effective laboratory marker for early differential diagnosis of TMB with the cut-off value of 9 U/L. Dynamic changes of CSF-ADA activity may be a indicator for the effect of antitubercular treatment.