结核性脑膜炎脑脊液分析的临床意义

目的:分析结核性脑膜炎患者脑脊液特点及与临床的关系。方法:回顾性分析2004～2009年首次确诊入院但未经治疗的90例结核性脑膜炎患者的临床及实验室资料。结果:结核性脑膜炎患者脑脊液压力、蛋白定量、糖定量、氯定量、白细胞计数、腺苷脱氨酶活性均出现不同程度异常。脑脊液白细胞数升高、单核细胞数降低与病程无相关性(P>0.05)。脑脊液蛋白水平升高与意识障碍有相关性(P<0.05)。结论:深入分析脑脊液各项指标,对结核性脑膜炎患者的治疗和预后判断具有重要作用。     

成人结核性脑膜炎脑脊液早期改变

目的 探讨成人结核性脑膜炎(结脑)早期脑脊液检测对结脑的诊断意义.方法 回顾性分析住院结脑患者48例,化验脑脊液常规、生化、抗酸染色等结果.结果 结脑患者早期颅内压升高者占77.1%;细胞数升高者占75%;蛋白升高者占66.7%;葡萄糖下降者占72.9%;氯化物下降者占62.5%;抗酸染色阳性率为0%;存在脑外结核者占31.2%.结论 脑脊液常规及生化检查阳性率高,是临床常用的诊断结脑的工具;细菌学检查阳性率低,不能依赖于细菌学检查.     

改良聚合酶链反应快速诊断结核性脑膜炎

目的：建立改良的聚合酶链反应的实验方法，快速诊断结核性脑膜炎。方法：应用二步控温洽酶链反应技术检测脑脊液结核杆菌微量ＤＮＡ。结果：经是 铲的４０例结核性脑膜炎聚合酶链反应扩增脑脊液ＤＮＡ全部阳性，２４例不明原因的中枢神经系统感染患者，１６例为阳性，而其它病原体引起的中枢神经系统感染和正常对照组均无扩增反应。结论：二步控温聚合酶链反应技术快速诊断结核性脑膜炎与传统的检验方法相比较，具有快速、敏感、高     

鞘内给药加脑脊液置换在结核性脑膜炎中的应用

目的探讨鞘内给药加脑脊液置换在结核性脑膜炎中的应用。方法随机选择结核性脑膜炎23例在抗结核治疗的同时进行鞘内给药加脑脊液置换，观察症状和体征的改善时间及脑脊液的变化。结果采用鞘内给药加脑脊液置换后临床症状迅速缓解及有症状期明显缩短。结论鞘内给药加脑脊液置换是治疗结核性脑膜炎的有效的方法之一。     

胸腔积液中肿瘤坏死因子和腺苷脱氨酶含量对结核性胸？…

目的;探讨肿瘤坏死因子和腺苷脱氨酶对结核性胸膜炎的诊断价值。方法：ＡＤＡ采用比色法,ＴＮＦ采用ＥＬＩＳＡ法对２７例恶性胸腔积液,５２例结核性胸腔积液进行了检测。结果：结核性胸腔积液ＡＤＡ和ＴＮＦ水平都明显高于恶性胸腔积液,差别具有显著性。结论：应用ＴＮＦ和ＡＤＡ可能有助于结核性胸膜炎的鉴别诊断。     

血清腺苷脱氨酶在肝病诊断中的特异性

目的:通过测定血清中腺苷脱氨酶(ADA)的活性,来了解ADA在肝病诊断中的临床价值和特异性。方法:用速率法测定肝功能损伤者和正常健康人组的腺苷脱氨酶及转氨酶(ALT)值。结果:通过ADA及ALT的测定结果,表明77例病人ADA与ALT值明显高于正常人,除黄疸标本升高不明显外,其余各组均有非常显著的升高。结论:ADA对各肝脏疾病的诊断有较高的特异性,对肝脏功能是否损伤有一定的临床意义。     

单克隆抗体酶联免疫吸附试验在结核性脑膜炎诊断中的初步应用

应用单克隆抗体酶联免疫吸附试验检测38例结核性脑膜炎、33例其它脑膜炎和112例非脑膜炎患者脑脊液中的结核杆菌抗原和抗体。结果脑脊液结核抗原阳性率为81.6％,假阳性率为2.8％;结核抗体阳性率为86.6％,假阳性率为3.4％,提示本法可作为结核性脑膜炎有效的辅助诊断方法。动态观察尚可为疗效判断提供依据。     

脑脊液C反应蛋白、前白蛋白、腺苷脱氨酶和β2-微球蛋白水平在儿童脑膜炎诊断中的临床价值

目的 探讨脑脊液C反应蛋白、前白蛋白、腺苷脱氨酶和β2-微球蛋白水平变化在儿童脑膜炎诊断中的临床价值.方法 检测儿童脑膜炎患者脑脊液C反应蛋白、前白蛋白、腺苷脱氨酶和β2-微球蛋白四者水平,与对照组进行比较并进行统计学分析.结果 与对照组比较,脑膜炎组的C反应蛋白、腺苷脱氨酶和β2-微球蛋白水平显著升高,前白蛋白水平明显降低.与结核性脑膜炎组比较,病毒性脑膜炎组的前白蛋白水平,细菌化脓性脑膜炎组的C反应蛋白和前白蛋白水平均明显升高;与病毒性脑膜炎组比较,细菌化脓性脑膜炎组、结核性脑膜炎组的腺苷脱氨酶和β2-微球蛋白水平显著升高.与对照组比较,脑膜炎组C反应蛋白、前白蛋白和腺苷脱氨酶三者单独检测,及上述四者联合检测的阳性率均明显升高,差异均有统计学意义(P<0.01或P<0.05).结论 联合检测脑脊液C反应蛋白、前白蛋白、腺苷脱氨酶和β2-微球蛋白水平对儿童脑膜炎诊断具有重要临床价值.     

结核性脑膜炎患者脑脊液基质金属蛋白酶-9的检测意义

在脑膜炎的发展过程中,基质金属蛋白酶-9(MMP-9)对降解基底膜和损伤血脑屏障发挥重要作用,结核分枝杆菌能够刺激单核-巨噬细胞过度表达MMP-9.为检测结核性脑膜炎患者脑脊液MMP-9水平,评价其对结核性脑膜炎诊断及治疗的意义,应用ELISA方法检测12例结核性脑膜炎和9例病毒性脑膜炎患者脑脊液MMP-9水平,并选取5例非肿瘤非感染性头痛患者脑脊液作对照组.结果显示,结核性脑膜炎脑脊液MMP-9的水平显著增高,中枢神经系统并发症发生率与MMP-9的水平相关.结论为脑脊液MMP-9水平对结核性脑膜炎的诊断和预后有参考价值.     

Diagnostic accuracy of droplet digital PCR analysis of cerebrospinal fluid for tuberculous meningitis in adult patients

ObjectivesTuberculous meningitis (TBM) is difficult to diagnose. Digital PCR (dPCR) is a novel method which can quantify trace nucleic acids. This study sought to evaluate the diagnostic accuracy of dPCR analysis of cerebrospinal fluid (CSF) for TBM.MethodsWe collected CSF specimens from hospitalized TBM and non-TBM patients. Total CSF DNA was purified and the concentrations of Mycobacterium tuberculosis insert sequence 6110 (IS6110) and gyrase subunit B (gyrB) were quantified using droplet dPCR. The receiver operating characteristic curves of dPCR were established and the diagnostic performances were obtained. We also compared the sensitivity of dPCR with routine diagnostic tests.ResultsA total of 101 patients were recruited, 68 of whom suffered from TBM (26 definite, 34 probable and eight possible TBM) and 33 from non-TBM. The sensitivity of IS6110-dPCR assay for total TBM was higher than that of gyrB-dPCR assay (57.4% (44.8–69.3%) vs. 22.1% (12.9–33.8%)), and there was no significant difference for specificity between them (97.0% (84.2–99.9%) vs. 100% (89.4–100.0%)). The sensitivity of IS6110-dPCR in definite TBM was higher than that in probable and possible TBM (73.1% vs. 52.9% and 25.0%, respectively). IS6110-dPCR assay showed a higher sensitivity than smear microscopy (53.3% vs. 6.7%), mycobacterial culture (50.0% vs. 12.5%), IS6110-quantitative PCR (53.1% vs. 21.9%) and Xpert MTB/RIF (70.4% vs. 29.6%). Long anti-tuberculosis treatment time was found to be significantly associated with negative dPCR results.ConclusionCSF IS6110-dPCR assay is a rapid and sensitive molecular test, which has the potential to be used to enhance the diagnosis of TBM.     

Proinflammatory cytokine levels in the serum and cerebrospinal fluid of tuberculous meningitis patients

The pathophysiology underlying tuberculous meningitis (TBM), the most prominent extra pulmonary tuberculosis and a serious public health problem in developing countries is still unclear. Whereas, tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) are cytokines involved in cell-mediated immune response. TNF-alpha and IFN-gamma production has earlier been shown to be associated with tissue necrosis. To see whether these cytokines have any role to play in the pathophysiology of TBM, we measured the levels of serum and cerebrospinal fluid (CSF) TNF-alpha and IFN-gamma in 31 consecutive patients of TBM by ELISA. There was a remarkable rise (P<0.001) in the levels of serum and CSF TNF-alpha and IFN-gamma levels in TBM patients with respect to 20 age and sex-matched control subjects. Furthermore, TNF-alpha and IFN-gamma levels showed a positive correlation with the severity of the disease at the end of 6 months of antibiotic therapy. Elevated TNF-alpha and IFN-gamma levels, especially in CSF, despite of these patients undergoing multidrug therapy suggests the persistence of central nervous system inflammation. We also found an associated rise (P<0.001) in the nitric oxide (NO) levels of serum and CSF but there was no correlation between NO levels and the severity of TBM. The continuous release of cytokines despite these patients undergoing anti-tubercular therapy suggests that TBM severity may result mainly from the immune response rather than the organism itself.     

Penetration of fusidic acid and rifampicin into cerebrospinal fluid in low-grade inflammatory meningitis caused by Staphylococcus epidermidis

Cerebrospinal fluid (CSF) concentration-time curves of rifampicin and fusidic acid were studied in a patient with post-operative meningitis caused by Staphylococcus epidermidis. The patient was treated with this combination of antimicrobial agents because of a severe hypersensitivity reaction to vancomycin. Peak CSF concentrations of rifampicin exceeded the MIC by > 60-fold, while those of fusidic acid just reached the MIC. CSF concentrations of fusidic acid were relatively stable within the range reported for patients with uninflamed meninges, but serum levels were surprisingly low. An increase in the metabolism of fusidic acid induced by rifampicin cannot be excluded.     

用ABC-ELISA提高检测脑脊液结核抗体的敏感性

本文用ABC—ELISA检测40例结核性脑膜炎及66例对照患者CSF中特异性IgG抗体,并在同一滴定板上做常规ELISA对比。结果表明ABC—ELISA检测CSF抗体滴度高于常规ELISA的3倍;抗体阳性的检出时间ABC法也早于常规法1天;其阳性检出率也明显高于常规法(p<0.05),而其非特异性未见增加,提示本法可能为结核性脑膜炎的免疫学诊断提供一种比常规ELISA更为敏感的新方法,有助于低抗体水平患者的检出。     

Chemokine profiles in the cerebrospinal fluid (CSF) during the course of pyogenic and tuberculous meningitis

The concentrations of the chemokines IL-8, monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α) were measured in 120 CSF samples from 23 patients with pyogenic meningitis and from 11 patients with tuberculous meningitis (TBM) and in 10 CSF from subjects with non-infectious neurological diseases. The chemokine concentrations in patients with meningitis were significantly higher than in control subjects (P < 0.0001). The highest CSF levels were found for IL-8 (median 2917 pg/ml) and MCP-1 (median 2557 pg/ml), whereas those of MIP-1α were less significantly elevated (median 24 pg/ml) (P < 0.0001). Patients with pyogenic meningitis had higher levels of IL-8 and MCP-1 than those with TBM (P < 0.0001). In serial samples from patients with pyogenic meningitis IL-8 levels declined before MCP-1 and MIP-α. In the case of TBM, IL-8, MCP-1 and MIP-1α decreased more gradually during treatment and were detectable in the CSF for several weeks, without any characteristic time course of elimination. These data indicate that patients with pyogenic meningitis and TBM show different chemokine profiles in CSF. The distinct chemokine pattern could be responsible for a differential attraction and activation of leucocytes in the CSF which is reflected in differences in the inflammatory response and clinical course of pyogenic meningitis and TBM.     

结核性脑膜炎患者的经颅多普勒超声和脑电图检测

目的：探讨经颅多普勒超声（ＴＣＤ）和脑电图（ＥＥＧ）在结核性脑膜炎中的应用价值。方法：对８０例结核性脑膜炎进行ＴＣ Ｄ和ＥＥＧ检测与分析。结果：治疗前８６％的ＥＥＧ和８１％的ＴＣ Ｄ均显示异常。治疗后除个别病例外，随着临床症状好转和痊愈，ＴＣＤ和 ＥＦＧ也好转或恢复正常。结论：用 ＴＣＤ和ＥＥＧ观察结核性脑膜炎的演变过程对估计预后有重要意义。     

The production of IL-8 in cerebrospinal fluid in aseptic meningitis of children

Neutrophils accumulate initially in the cerebrospinal fluid (CSF) of aseptic meningitis, perhaps because of increased levels of granulocyte colony-stimulating factor (G-CSF), macrophage inflammatory protein-1α (MIP-1α), and IL-8 in the subarachnoid space. We studied levels of these cytokines in children with aseptic meningitis using ELISA. When meningeal symptoms existed, IL-8 levels (1399 ± 1600 ng/l, n= 32) in the CSF were significantly higher than those either after meningeal symptoms disappeared (61 ± 56 ng/l, n= 18) or in controls (44 ± 63 ng/l, n= 27) ( P < 0.0001). High levels of IL-8 on admission dropped sequentially. Significant correlations were found between IL-8 levels and either neutrophil counts (r= 0.612), G-CSF levels (r= 0.873) or MIP-1α levels (r= 0.623) in the CSF of the affected patients (P< 0.0001). IL-8 values in serum were lower than in the corresponding CSF samples from all individuals with meningeal symptoms. The IL-8 mRNA was detectable by reverse-transcribed polymerase chain reaction (PCR)-assisted amplification in fresh leucocytes from the CSF, but not from the peripheral blood of a healthy volunteer. The culture of CSF mononuclear cells produced high levels of IL-8 (~ 2750 ng/l). These data indicate that IL-8 levels rise transiently at the initial stage of aseptic meningitis, and that mononuclear cells that migrate into the CSF are a cellular source of this chemokine. We suppose that IL-8, in addition to G-CSF and MIP-1α, contribute to the localized neutrophil accumulation during the disease.     

Picornaviruses in cerebrospinal fluid of children with meningitis in Luanda, Angola

Human enteroviruses are the most common cause of viral meningitis. Viral-bacterial interaction may affect the clinical course and outcome of bacterial meningitis. In Africa, viruses might be responsible for 14-25% of all meningitis cases. However, only few studies from Africa have reported detection of viruses in the cerebrospinal fluid (CSF) or mixed viral-bacterial infections of the central nervous system (CNS). The aim of the present study was to investigate the presence of picornaviruses in the CSF of children suffering from meningitis in Luanda, Angola. The study included 142 consecutive children enrolled in a prospective study of bacterial meningitis in Luanda between 2005 and 2006, from whom a CSF sample was available. CSF samples were obtained at hospital admission, stored in a deep-freeze, and transported to Finland for testing by real-time PCR for picornaviruses. Enteroviruses were detected in 4 (3%) of 142 children with presumed bacterial meningitis. A 5-month-old girl with rhinovirus and Haemophilus influenzae meningitis recovered uneventfully. An 8-year-old girl with human enterovirus and pneumococcal meningitis developed no sequelae. A 2-month-old girl with human enterovirus and malaria recovered quickly. A 7-month-old girl with human enterovirus was treated for presumed tuberculous meningitis and survived with severe sequelae. Mixed infections of the CNS with picornaviruses and bacteria are rare. Detection of an enterovirus does not affect the clinical picture and outcome of bacterial meningitis.     

Evaluation of combining upper respiratory tract swab samples with cerebrospinal fluid examination for the diagnosis of enteroviral meningitis in children

In a prospective comparative study, the use of combined analysis of upper respiratory tract swab samples and cerebrospinal fluid (CSF) samples was assessed to improve the detection rate of enteroviral meningitis in children. An enterovirus was detected in 32% of patients with aseptic meningitis when testing CSF samples alone compared with 71.5% when combining CSF and respiratory tract findings. An enterovirus was detected in 17% of respiratory tract samples in an age- and sex-matched control group without meningitis. Thus, combining the examination of upper respiratory tract with CSF findings may improve the detection rate of enteroviral meningitis. Upper respiratory tract samples should be included in the diagnosis scheme to differentiate benign enteroviral meningitis from other life-threatening infections of the central nervous system. J. Med. Virol. 57:193–197, 1999. © 1999 Wiley-Liss, Inc.