脑脊液腺苷脱氨酶检测对结核性脑膜炎诊断的价值

目的探讨脑脊液腺苷脱氨酶（ADA）检测对结核性脑膜炎诊断的价值。方法对27例结核性脑膜炎患者及68例非结核性脑膜炎患者进行脑脊液ADA活性检测及分析。结果结核性脑膜炎组ADA活性范围明显高于非结核性脑膜炎组,差异有统计学意义（P〈0．01）。结论脑脊液腺苷脱氨酶活性升高可作为结核性脑膜炎诊断的一个重要辅助指标。     

脑脊液腺甘脱氨酶及结核抗体测定在结核性脑膜炎中的诊断价值

结核性脑膜炎(结脑)是常见的中枢神经系统感染性疾病，在临床上常见。但在诊断上尚有一定的困难。现将我院2年内检测100例腺甘脱氨酶(ADA)与结核抗体检测结果报道如下。     

结核性脑膜炎脑脊液免疫学诊断

结核性脑膜炎（tuberculous meningitis,TBM）是一种病死率和致残率很高的中枢神经系统感染性疾病,临床表现缺乏特异性,病情变化迅速,早期诊断困难。近年来,TBM的脑脊液（CSF）免疫学诊断以其极高的敏感性和特异性得到迅速发展,临床应用前景广阔。现就TBM的CSF免疫学诊断做一综述。     

脑脊液中检测DLL1对结核性脑膜炎的诊断意义

目的探索脑脊液(CSF)中Delta-like-1(DLL1)的检测在结核性脑膜炎诊断中的临床价值。方法选择诊断明确的中枢神经系统感染性疾病患者50例,分为结核性脑膜炎(结脑组)30例,病毒性脑(膜)炎(病脑组)20例,以及正常对照组20例,颅内转移瘤(肿瘤组)8例。采用酶联免疫吸附试验定量测定患者CSF中DLL1的含量。结果各组CSF中DLL1的含量,结脑组显著高于其他组别,差异均有统计学意义(P<0.01),其他组别之间相比差异均无统计学意义(P>0.05)。各组CSF中DLL1的含量与CSF蛋白、细胞数、葡萄糖、氯化物及颅内压均无相关性。结论 DLL1检测作为一种新的指标,在结核性脑膜炎的诊断中可能有重要临床价值。     

结核性脑膜炎50例脑脊液检查结果分析

我科白2005—01～2009—06对50例结核性脑膜炎患者的脑脊液（CSF）进行检测,结果报告如下。     

脑脊液中抗BCG抗体分泌细胞测定对结核性脑膜炎鉴别诊断价值的研究

用酶联免疫斑点(Elispot)法，将BCG作为抗原，对16例结核性脑膜炎33例次脑脊液中淋巴细胞分离培养，从体外检测BCG特异性IgG抗体分泌细胞，结果表明总阳性率为91．7％，对照组(其它颅内炎症)18例共22例次检测无1例阳性。提示采用本法对结核性脑膜炎进行诊断具有特异性。     

脑脊液淋巴样细胞检出对结核性脑膜炎早期诊断价值

目的：为了使脑脊液细胞学检查能对结核性脑膜炎提供早期诊断依据。方法：用侯氏法收集脑脊液细胞,对７８例结核性脑膜炎与８５例其它中枢神经系统感染患者脑脊液细胞学结果经分析。结果：结核性脑膜炎脊液中淋巴样细胞和浆检出阳性率分别为９５％和６２％,而毒性脑膜炎则为７３％和４９％、隐球菌性脑膜炎为５０％和３３％、寄生虫性脑膜炎为５６％和３１％、化脓性脑膜炎为２５％和１３％,均明显低于结核性脑膜炎、结论：脑脊液     

结核性脑膜炎脑脊液检测项目研究的进展

结核性脑膜炎 (ＴＢＭ)是中枢神经系统常见的感染性疾病 ,其预后取决于早期诊断和及时治疗。ＴＢＭ的诊断 ,除临床症状、体征外 ,脑脊液 (ＣＳＦ)的实验室检测极其重要。现将近年来有关ＣＳＦ检测项目在ＴＢＭ诊断的进展综述如下。1　细胞学检查ＴＢＭ的ＣＳＦ细胞学改变具有一定的规律性特征 ,许多学者主张将其细胞学列为ＴＢＭ的常规检查项目。ＴＢＭ的ＣＳＦ细胞学的特点是以嗜中性粒细胞为主伴一定数量的免疫活性细胞 (小淋巴细胞、淋巴样细胞和浆细胞 )和单核吞噬细胞的混合细胞反应 ,亦可见到嗜酸性粒细胞。尽管持续抗结核治疗 ,ＣＳ…     

脑脊液腺苷脱氨酶及结核抗体在结核性脑膜炎中的诊断价值

目的 了解结脑患者腺苷脱氨酶(ADA)活性变化及结核抗体(TB-Ab)的阳性率.方法 TB-Ab采用酶联免疫吸附(ELISA)法,ADA用波氏显色法.结果 结脑患者ADA活性升高明显,同时TB-Ab的阳性率亦较高.结论 结脑患者ADA活性明显升高,与对照组比较其差异有统计学意义(P＜0.05),TB-Ab的阳性率22.2%.     

结核性脑膜炎脑脊液结核分枝杆菌抗原的动态变化分析

目的探讨结核性脑膜炎(结脑)脑脊液结核分枝杆菌(MTB)抗原的动态变化。方法对临床诊断为结脑及病毒性脑膜炎(病脑)的患者各30例进行脑脊液MTB抗原动态分析,分别于发病第1、2、4周进行脑脊液单核细胞MTB抗原免疫组织化学染色,进行阳性细胞计数并统计阳性病例数。结果结脑组第1周脑脊液MTB抗原阳性27例(90%),阳性细胞比例(22.6±1.6)%,第2周阳性27例(90%),阳性细胞比例(21.8±2.1)%,第4周阳性9例(30%),阳性细胞比例(10.5±1.1)%;第1、2周MTB抗原阳性率及阳性细胞比例明显高于第4周(P<0.01)。病脑组第1周MTB抗原阳性3例(10%),阳性细胞比例为(5.2±1.3)%,第2、4周检测结果均为阴性。结脑组第1周较病脑组MTB抗原阳性例数及阳性细胞比例明显升高(P<0.01)。MTB抗原检测早期结脑(发病2周内)敏感性、特异性均达90%。结论脑脊液MTB抗原检测有助于结脑的早期诊断。     

脑脊液中检测结核分枝杆菌特异性抗原对结核性脑膜炎的诊断意义

目的 应用改进的斑点酶联免疫吸附法(Dot ELISA)检测脑脊液中结核分枝杆菌特异性抗原培养滤液蛋白10(CFP10)和6000早期分泌性抗原靶(ESAT-6),评价其在结核性脑膜炎(TBM)中的诊断价值.方法 收集111例患者的脑脊液,其中58例临床诊断为TBM,53例非TBM,应用Dot ELISA法分别检测脑脊液中CFP10和ESAT-6并进行分析.结果 检测CFP10抗原的敏感度为93.1%,特异度为92.5%;检测ESAT-6抗原的敏感度为91.4%,特异度为94.3%.两项检测的敏感度和特异度均普遍高于针对结核分枝杆菌菌体或菌体物质进行检测的同类研究,如抗酸染色、结核分枝杆菌培养、聚合酶链反应等.结论 应用改进的Dot ELISA法检测脑脊液中CFP10和ESAT-6对诊断TBM有很高的敏感度和特异度,为结核分枝杆菌特异度抗原用于临床结核病诊断提供了依据.

Abstract：

Objective To evaluate the detection of culture filtrate protein 10 (CFP10) and 6000 early secretory antigenic target (ESAT-6) in cerebrospinal fluid to be used in diagnosing tuberculous meningitis. Methods Dot enzyme linked immunosorbent assay ( Dot ELISA) method that was improved by applying concentrated cerebrospinal fluid was used to detect CFP10 and ESAT-6 in cerebrospinal fluid to analyze small protein antigen secreted by M. tuberculosis. Cerebrospinal fluid of 111 subjects were collected,in which 58 specimens were clinically diagnosed as tuberculous meningitis and 53 as non-tuberculous.CFP10 and ESAT-6 were detected in cerebrospinal fluid using Dot ELISA method and the results were analyzed. Results The sensitivities of detecting CFP10 and ESAT-6 antigen were 93.1% and 91.4% respectively, and the specificities were 92. 5% and 94. 3% respectively. The sensitivities and specificities are generally higher compared with the other methods of detecting M. tuberculosis or materials of M. tuberculosis by acid-fast staining or mycobacterium tuberculosis culture and polymerase chain reaction.Conclusions Using Dot ELISA method to detect CFP10 and ESAT-6 in cerebrospinal fluid to diagnose tuberculous meningitis has a high sensitivity and specificity. Our study provided the evidence of detecting the specific antigen of M. tuberculosis to be used in diagnosing tuberculosis.     

Rapid diagnosis of tuberculous meningitis by polymerase chain reaction assay of cerebrospinal fluid

A polymerase chain reaction (PCR) method for the rapid diagnosis of tuberculous meningitis (TBM) was used to study prospectively 47 cerebrospinal fluid (CSF) samples from 45 patients. Twenty CSF samples were from patients with clinically suspected TBM and another 27 samples came from patients without clinically suspected TBM. Mycobacterial DNA was detected in 15 CSF samples (14 from patients with clinically suspected TBM and 1 from a patient not suspected of having TBM). Of the PCR-positive samples, 4 were also positive for mycobacterial culture. However, 32 PCR-negative samples were all culture-negative. All samples were negative for the acid-fast bacillus by direct smear. The single PCR-positive patient in the clinically unsuspected TBM group was initially diagnosed as suffering from aseptic meningitis on the basis of his clinical features. The mycobacterial culture of his CSF specimen was also positive and a revised diagnosis of an aseptic type of TBM was made. The estimations of specificity and sensitivity in this study were 100% and 70% respectively. The results showed that using a PCR to detect mycobacterial DNA in CSF for the early diagnosis of TBM is not only a rapid but also an accurate method.     

Adenosine deaminase activity in cerebrospinal fluid and serum for the diagnosis of tuberculous meningitis

Objective

To evaluate the usefulness of serum and CSF adenosine deaminase (ADA) activity for the diagnosis of tuberculous meningitis (TBM) from other meningitis.

Methods

We studied CSF and serum ADA activity for 83 cases of TBM, 148 of bacterial meningitis (BM), and 262 of viral or aseptic meningitis.

Results

The mean ADA activities (IU/L) in CSF and serum were higher in TBM (11.80 ± 2.50, 30.28 ± 7.30) than in other types of meningitis (8.52 ± 3.60, 17.90 ± 9.20 in BM; 5.26 ± 1.90, 8.56 ± 5.9 in viral or aseptic meningitis). When we accepted a serum ADA activity cut-off value of 15 IU/L for the differential diagnosis of TBM and non-TBM with ROC analysis, the sensitivity was 84% and specificity was 82%. Combining CSF (≥10) and serum (≥15) ADA activity significantly increased overall specificity from 92% to 97% for the diagnosis of TBM.

Conclusions

The determination of CSF and serum ADA activity is a simple and reliable test for differentiating TBM from other types of meningitis.     

脑脊液单核细胞内结核抗原检测对结脑早期诊断的意义

目的:评价检测脑脊液中单核细胞内的结核抗原对结核性脑膜炎早期诊断的意义,为结脑的早期诊断提供有效的方法。方法:将30例结脑患者与30例对照组进行脑脊液常规、生化、细胞学检查,同时用免疫荧光法检测脑脊液中单核细胞内的结核抗原,并进行动态观察。结果:结脑患者脑脊液中单核细胞内存在结核抗原,在30例结脑患者中25 例显示阳性,而对照组无一例阳性,敏感性为83.3%,特异性为100%。动态观察显示,最早检出者为发病7天,多次检测可持续阳性。结论:检测脑脊液中单核细胞内结核抗原是结脑早期诊断的一个手段。     

结核性脑膜炎脑脊液细胞学的特征性表现

目的探讨脑脊液细胞学检查对结核性脑膜炎早期临床诊断的价值。方法采用玻片离心沉淀法制片收集脑脊液细胞,瑞-姬姆萨染色(MGG),光学显微镜分类计数。结果37例临床诊断为结核性脑膜炎患者的脑脊液细胞学呈以下改变:细胞学形态以斑片状聚集分布的激活型单核细胞、单核吞细胞和巨噬细胞,周围伴中性粒细胞和淋巴细胞,中性粒细胞比例为35.57±22.95%,类似于无反应性肉芽肿样改变。结论形似无反应性肉芽肿样的脑脊液细胞学改变以及中性粒细胞特征性的比率,可能是结核性脑膜炎早期诊断的特征性改变。