结核性脑膜炎血清脑脊液结核抗体联合测定意义

结核性脑膜炎(以下称结脑)是最危险的肺外结核病之一.由于不典型病例增多,脑脊液的实验室检测十分重要.国内外一些资料已报道脑脊液中结核分支杆菌抗体检测,有助于结脑的诊断与鉴别诊断.自1999年以来,以PPD为抗原,采用ELISA法对28例结脑患者的血清、脑脊液中结核抗体联合测定,并同时测定肺结核11例,其他疾病(非结核病)12例血清、脑脊液中的结核抗体并作对比.     

PCR技术检测结核性脑膜炎病人脑脊液中的人型结核分支杆菌的研究

采用聚合酶链式反应（ＰＣＲ）技术，检测人型结核分支杆菌。扩增片段为１６５ｂＰ，非结核分支杆菌和其它细菌结果阴性，证实其具有较高的特异性。通过与常规ＤＮＡ制备方法的比较，证明对脑脊液标本煮沸后进行直接扩增，方便、快捷、不影响实验结果。对３３例结核性脑膜炎及２６例非结核性脑膜炎病人的脑脊液进行结核分支杆菌ＤＮＡ检测，并与其它诊断方法进行比较，结果显示：ＰＣＲ的阳性率为：８４．８％（２８／３３），抗酸染色３％（１／３３），抗原检测６０．６％（２０／３３），抗体检测为５４．５％（１８／３３），对照组无１例阳性，表明ＰＣＲ技术在特异性和敏感性方面均优于上述方法，可望成为结脑可靠的诊断手段。     

脑脊液置换加鞘内注药治疗结核性脑膜炎的疗效分析

结核性脑膜炎(简称结脑)临床症状严重,致残率和病死率高,治疗较困难,疗效欠佳.对26例结脑患者在常规治疗的基础上,加用脑脊液置换及鞘内注药等综合治疗,取得良好临床效果.     

3.0 T磁共振灌注加权成像在脑星形细胞瘤分级诊断中的价值

目的 探讨对比剂首过MR灌注加权成像(perfusion weighted imaging,PWI)在脑高、低级别星形细胞瘤鉴别诊断中的价值.资料与方法 分析40例经手术病理证实的星形细胞瘤患者的MRI资料,所有患者术前均行常规MRI平扫+增强、PWI,其中低级别组(WHOⅠ、Ⅱ级)14例,高级别组(WHO Ⅲ、Ⅳ级)26例.结果 常规MR平扫+增强扫描诊断高级别星形细胞瘤的敏感性为69.2%,特异性为64.3%,阳性预测值为78.3%,阴性预测值为52.9%,准确性为67.5%.高、低级别星形细胞瘤瘤体实质相对脑血容量(rCBV)值和相对脑血流量(rCBF)值差异均有统计学意义(P<0.05),而相对平均通过时间(rMTT)值差异无统计学意义(P>0.05).选择Youden指数最大值作为高、低级别星形细胞瘤最佳诊断临界点时,瘤体实质rCBV值受试者工作特征(ROC)曲线下面积(AUC)为0.961,阈值为2.71,敏感性为85.0%,特异性为100%,阳性预测值为100%,阴性预测值为78.0%;瘤体实质rCBF值ROC曲线的AUC为0.877,阈值为1.45,敏感性为85.0%,特异性为71.0%,阳性预测值为85.0%,阴性预测值为71.0%.结论 与常规MRI比较,对比剂首过PWI能提高术前星形细胞瘤分级诊断的准确性.瘤体实质rCBV值是星形细胞瘤分级诊断的最特异性指标.     

中枢神经系统炎症患者脑脊液S-100Β蛋白和神经元特异性烯醇化酶含量的测定

为了探讨脑脊液(CSF)S-100Β蛋白和神经元特异性烯醇化酶(NSE)含量对中枢神经系统(CNS)炎症患者脑损伤的评估价值,采用酶联免疫吸附试验双抗体夹心法对42例单纯疱疹病毒性脑炎(病脑组)、19例化脓性脑膜炎(化脑组)、17例隐球菌性脑膜炎(隐脑组)患者和22例无神经系统疾病、无肿瘤的外科腰麻患者(对照组)CSF中的S-100Β蛋白和NSE进行了动态观察.结果显示,3组CNS炎症患者脑脊液 S-100Β蛋白含量均显著高于对照组(P＜0.01),其中病脑组＞化脑组＞隐脑组(P＜0.01);脑脊液NSE含量病脑组最高,与化脑组和隐脑组相比差异有著性意义(P＜0.05和P＜0.01),隐脑组与对照组差异无显著性意义(P＞0.05);动态检测发现,脑脊液S-100Β蛋白和NSE含量随3组CNS炎症患者病情的轻重而发生相应的变化.研究表明,3组CNS炎症患者脑脊液 S-100Β和NSE含量均有不同程度的增高,且与患者脑损伤的严重程度有关.     

脑脊液置换联合鞘内注药治疗结核性脑膜炎的临床观察

目的探讨脑脊液置换联合鞘内注药治疗结核性脑膜炎的临床疗效。方法采用脑脊液置换联合鞘内注药治疗结核性脑膜炎26例(治疗组)和常规抗结核药物及激素、脱水剂等治疗28例(对照组)。对两组的疗效和脑脊液压力、蛋白、糖、氯化物及细胞数恢复时间,住院天数进行比较。结果治疗组治愈率(92.3%)与对照组治愈率(71.4%)相比有显著性差异(P<0.05);治疗组脑脊液蛋白、压力、糖、氯化物、细胞数恢复正常时间均较对照组明显缩短(P<0.01)。结论脑脊液置换联合鞘内注药可缓解结核性脑膜炎的症状,缩短疗程,该方法是治疗结核性脑膜炎的一种简单、有效、安全的方法。     

脑脊液免疫球蛋白及C-反应蛋白对老年感染性脑膜炎的诊断价值

目的探讨脑脊液免疫球蛋白及C-反应蛋白(CRP)对老年感染性脑膜炎的诊断价值。方法分析2018年6月-2019年6月90例老年感染性脑膜炎患者的临床资料,作为研究组;选取同期90例以头痛为主诉入院的非感染性脑膜炎老年患者,作为对照组。两组均检测免疫球蛋白(IgA、IgM、IgG)、CRP,比较组间差异,并评估诊断价值。结果研究组脑脊液IgA、IgM、IgG、CRP水平高于对照组(P<0.05);病毒性脑膜炎IgA、IgG诊断阳性率高于结核性、细菌化脓性脑膜炎(P<0.05);细菌化脓性脑膜炎IgM、CRP诊断阳性率高于病毒性、细菌化脓性脑膜炎(P<0.05)。结论老年感染性脑膜炎诊断中脑脊液免疫球蛋白及CRP检测应用价值较高。     

检测腺苷脱氨酶对结核性与癌性胸、腹水的诊断意义

目的 :探讨腺苷脱氨酶对结核性与癌性胸、腹水鉴别诊断的意义。方法 :常规穿刺抽取胸、腹水5ml,离心后取上清液 ,采用Martinek’s法分别对结核性胸、腹水 71例和癌性胸、腹水 5 1例的腺苷脱氨酶(ADA)活性、敏感性、特异性、准确性进行测定。结果 :结核性胸、腹水ADA活性测定值显著高于癌性胸、腹水ADA活性测定值 ,两者有非常显著差异 (P <0 0 1)。以ADA活性 4 0 μ/L作为诊断界限值 ,诊断结核有很高敏感性 (95 8% )、特异性 (96 1% )与准确性 (95 9% )。结论 :ADA可作为胸、腹水结核感染的特异性诊断指标 ,对结核性与癌性胸、腹水有重要鉴别诊断意义     

急性肺栓塞所致右心功能不全的CTPA诊断价值

目的 探讨CT肺血管造影(CTPA)对急性肺栓塞(PE)所引起的右心功能不全(RVD)的诊断价值.方法 回顾性分析经CTPA确诊的、并于24 h内行超声心动图(UCG)检查的急性肺栓塞患者36例,并按病情严重性分为大面积肺栓塞组(24例)和非大面积肺栓塞组(12例).本研究以UCG的结果作为RVD的诊断标准,将CTPA的结果与UCG的结果相对照.CTPA诊断RVD的标准为在横切位CT图像上显示右心室增大(RVd/LVd>1)或室间隔异常移位.结果 36例肺栓塞患者中,UCG共诊断RVD阳性13例,阴性23例.CTPA诊断RVD阳性16例,阴性20例.以UCG为标准,CTPA的诊断敏感性为84.61%、特异性为78.26%、阳性似然比为3.892、阴性似然比为0.197、阳性预测值为68.75%、阴性预测值为90%,Kappa值为0.60,诊断具有中等一致性.24例大面积肺栓塞患者中,UCG诊断RVD阳性13例,阴性11例.CTPA诊断RVD阳性14例,阴性10例.以UCG为标准,CTPA的诊断敏感性为84.61%、特异性为72.73%、阳性似然比为3.103、阴性似然比为0.212、阳性预测值为78.57%、阴性预测值为80%,Kappa值为0.58,诊断具有中等一致性.12例非大面积肺栓塞患者中,UCG诊断均为RVD阴性.CTPA诊断RVD阳性2例,阴性10例,诊断特异性为83.33%.统计学分析发现,2组之间的RVd/LVd值有显著性差异,CTPA与UCG结果在大面积肺栓塞组有较好的相关性,而在非大面积肺栓塞组无明显相关性.结论 CTPA不仅可以对肺栓塞做出直接诊断,而且通过分析心脏的形态学改变,可以较为准确地判定肺栓塞患者是否伴发右心功能不全.     

脑脊液中TB-DNA实时荧光定量PCR分析的临床应用价值评价

目的 探讨实时荧光定量PCR法检测脑脊液中TB-DNA的临床应用价值.方法 收集具有神经系统症状患者的脑脊液标本106例,应用实时荧光定量PCR法检测TB-DNA.结果 106例中检测出TB-DNA阳性8例,总阳性率7.5%.检出的TB-DNA拷贝数最低为1.62e+001,最高为7.51e+002.结论 实时荧光定量PCR法检测脑脊液中TB-DNA对结核性脑膜炎的诊断有决定意义,具有较高临床应用价值.     

腺苷脱氨酶与癌胚抗原检测在胸腔积液诊断中的价值

目的分析腺苷脱氨酶（ADA）与癌胚抗原（CEA）检测在胸腔积液诊断和鉴别诊断中的应用价值。方法对46例自2008年9月～2009年6月我院经治有胸腔积液症状的患者检测胸腔积液和血清ADA、CEA水平,对不同疾病组结果分析比较。结果结核性胸腔积液组ADA为（43.00±13.82）U/L,CEA的含量为（1.25±1.22）μg/L;恶性胸腔积液组A-DA为（17.57±6.20）U/L,CEA为（293.74±197.50）μg/L。结核性胸腔积液组ADA含量较恶性胸腔积液组明显增高（P〈0.01）,恶性胸腔积液组CEA含量较结核性胸腔积液组明显增高（P〈0.01）。胸腔积液ADA（pADA）/血清ADA（sADA）及胸腔积液CEA（pCEA）/血清CEA（sCEA）比值,结核性胸腔积液组（2.69±0.83、1.05±0.89）与恶性胸腔积液组（0.87±0.22、9.47±5.91）相比有显著性差异（P〈0.01）,pADA及pCEA判断结核性胸腔积液的临界值分别为：39U/L、pCEA〈5μg/L,恶性胸腔积液的敏感性为95%、特异性为99.8%。结论胸腔积液腺苷脱氨酶与癌胚抗原测定对结核性胸腔积液和恶性胸腔积液的诊断具有重要价值。     

腺苷脱氨酶与癌胚抗原检测在胸腔积液诊断中的价值

目的分析腺苷脱氨酶（ADA）与癌胚抗原fCEA）检测在胸腔积液诊断和鉴别诊断中的应用价值。方法对46例自2008年9月-2009年6月我院经治有胸腔积液症状的患者检测胸腔积液和血清ADA、CEA水平。对不同疾病组结果分析比较。结果结核性胸腔积液组ADA为（43．00±13．82）U／L,CEA的含量为（1.25±1．22）μg／L;恶性胸腔积液组A-DA为（17．57±6．20）U／L,CEA为（293．74±197．50）±g／L。结核性胸腔积液组ADA含量较恶性胸腔积液组明显增高（P〈0．01）,恶性胸腔积液组CEA含量较结核性胸腔积液组明显增高愀0．01）。胸腔积液ADA（pADA）／BR清ADA（sADA）及胸腔积液CEA（pCEA）／血清CEA（sCEA）比值,结核性胸腔积液组（2．69±0．83、1．05±0．89）与恶性胸腔积液组（0．87±0．22、9．47±5．91）相比有显著性差异（P〈0．01）,pADA及pCEA判断结核性胸腔积液的临界值分别为：39U／L、pCEA〈51μg／L,恶性胸腔积液的敏感性为95％、特异性为99．8％。结论胸腔积液腺苷脱氨酶与癌胚抗原测定对结核性胸腔积液和恶性胸腔积液的诊断具有重要价值。     

联合检测胸水ADA、CEA、CA125、CA153在结核性与恶性胸水中的鉴别诊断价值

目的探讨联合检测胸水ADA、CEA、CA125、CA153对结核性与恶性胸水的鉴别诊断价值。方法收集114例已确诊胸腔积液患者的胸水,其中恶性组胸水64例,结核性胸水50例,检测两组患者胸水ADA、CEA、CA125、CA153水平。结果恶性组ADA明显低于结核组,而CEA、CA125、CA153水平明显高于结核组,两者差异显著。具有统计学意义。CEA、CA125、CA153对恶性胸水诊断的敏感性分别为73-4％、81．2％、43．8％,特异性分别为84．0％、46．0％、88．0％．准确性分别为79．8％、63．2％、66．7％,三项联合检测可显著提高诊断敏感性（93．4％）。ADA对结核性胸水的敏感性、特异性、准确性分别为83．4％、91．5％、87．6％。结论联合检测胸水ADA、CEA、CA125、CA153有助于结核性与恶性胸水的鉴别诊断。     

唾液腺苷脱氨酶测定在结核病诊断中的应用价值

对１１４例肺结核病人唾液腺苷脱氨酶（ＡＤＡ）活性做了测定，结果表明：肺结核组、肺外结核组以及非结核组的唾液ＡＤＡ活性显著高于正常对照组（Ｐ＜０．０１），结核性脑膜炎唾液ＡＤＡ活性最高。肺结核病人治疗后唾液ＡＤＡ活性低于治疗前。作者认为唾液ＡＤＡ检测有助于肺结核，结核性脑膜炎的诊断和疗效的评估。     

Tumor markers in pleural effusions in bronchogenic carcinoma and tuberculosis

Concentrations of carcinoembryonic antigen (CEA) and carborhydrate antigen (CA) 50 were measured in pleural effusion and sera of 57 patients with bronchogenic carcinoma and in 73 patients in whom the effusion was the sequela of tuberculous pleurisy. In the group with bronchogenic carcinomas, planocellular was confirmed in 19, microcellular in 17, macrocellular in 2, and adenocarcinoma in 18, while in 1 patient it was not possible to determine the histopathologic structure. The diagnosis of pleural disease was established upon the cytologic examination of the effusion and histopathologic examination of the pleural sample obtained by blind percutaneous needle biopsy or following pleuroscopy. CEA concentration in the sera of patients with bronchogenic carcinoma was significantly higher than in the patients with tuberculosis (p < 0.001), with sensitivity of 44% and ideal specificity and positive predictive value of 100%. In the same group highly significant difference of mean values of CEA concentrations in pleural effusion (p < 0.001), was also found with sensitivity of 60%, significant specificity of 99% and positive predictive value of 97%. CA 50 concentrations in the sera of patients with lung carcinoma were significantly higher than those in the sera of patients with tuberculous pleurisy (p < 0.05), and the sensitivity was 50%, while the specificity was 94% and positive predictive value was 75%. Significantly higher was also the value in the pleural effusion (p < 0.05), but the sensitivity was slightly lower--40%, but specificity was favorable as well as the positive predictive value (94 and 86%, respectively). The results indicate the significance of the determination of CEA and CA 50 in the sera and pleural effusion in the differentiation of malignant from tuberculous pleural effusion.     

Evaluating the CT diagnosis of Clostridium difficile colitis: should CT guide therapy?

OBJECTIVE: The purpose of this study was to further characterize the CT findings of Clostridium difficile colitis and to provide for the first time a diagnostic sensitivity, specificity, positive predictive value, and negative predictive value to help clinicians decide whether antibiotic treatment is warranted on the basis of CT findings while awaiting stool test results (which may take as long as 48 hr). MATERIALS AND METHODS: A retrospective review covering a 4-year period was performed of the charts and CT scans of 54 symptomatic patients with stool test results positive for C. difficile and of a control group of 56 patients with antibiotic-associated diarrhea with stool test results negative for C. difficile. RESULTS: At our institution, C. difficile colitis was explicitly diagnosed at CT in these patients with a sensitivity of 52%, specificity of 93%, positive predictive value of 88%, and negative predictive value of 67%. The sensitivity can be raised to 70% with no change in specificity with more rigid adherence to diagnostic criteria of colon wall thickening of greater than 4 mm combined with any one or more findings of pericolonic stranding, colon wall nodularity, the "accordion" sign, or otherwise unexplained ascites. CONCLUSION: Although routine CT screening of antibiotic-associated diarrhea is not advocated, the 88% positive predictive value of a diagnosis of C. difficile colitis in those who are scanned may merit consideration of treatment by clinicians on the basis of the CT results alone.     

Predictive value of digital subtraction angiography in patients with tuberculous meningitis

Digital subtraction angiography (DSA) was performed in 24 adults with tuberculous meningitis (TBM) and results were correlated with 24 admission and 16 follow-up CT examinations. 19 MRI studies and clinical outcome at a mean follow-up of 44 weeks. DSA was abnormal in 11 patients. Abnormal DSA was associated with advanced clinical stages of the Medical Research Council classification, admission CT with hydrocephalus or gyral cortical enhancement. MRI disclosed brain infarcts not seen on initial CT in 8 cases. Of seven patients who died, 4 had abnormal and 3 normal DSA. Among patients who survived, those with normal DSA had a better functional outcome by Karnofsky scores. During follow-up infarcts were evident in 16 patients. Abnormal DSA in relation to brain infarcts had a sensitivity of 0.56, specificity 0.75, positive predictive value 0.82 and negative predictive value 0.46. A single arteriogram does not predict the outcome in patients with TBM and its value is limited in the assessment of vascular complications of TBM. Angiography in TBM is justified only in specific clinical trials to assess new therapeutic modalities against infarcts.     

The validity of the motion palpation test for determining patellofemoral joint articular cartilage damage

ObjectivesThis study investigated the validity of the motion palpation test (MPT) for pre-operatively grading patellofemoral joint articular cartilage damage.DesignRetrospective review of cases.ParticipantsConsecutive patients (N=188) with suspected patellofemoral joint articular cartilage damage.ProcedureThe medical records of patients who underwent clinical examination using the MPT and proceeded to undergo knee arthroscopy were reviewed.ResultsBased on arthroscopic findings the MPT revealed excellent overall sensitivity (87%), positive test predictive value (97%), and accuracy (85%), but specificity (33%) and negative test predictive values (10%) were poor. However, overall likelihood ratios for a positive (1.3) or negative (0.39) test indicated only a minimal increase in the likelihood of having articular cartilage damage with a positive test, and only a small decrease in ruling-out the condition with a negative test. With a severe MPT crepitation grade subclassification, sensitivity was 65%, specificity was 96%, positive test predictive value was 99%, negative test predictive value was 38%, and accuracy was 99%. For a moderate MPT crepitation grade sensitivity was 77%, specificity was 44%, positive predictive value was 81%, negative predictive value was 38%, and accuracy was 81%. For a mild MPT crepitation grade sensitivity was 66%, specificity was 51%, positive test predictive value was 77%, negative test predictive value was 38%, and accuracy was 62%. Positive likelihood ratios for MPT crepitation grade subclassifications revealed a large and likely conclusive increase in the likelihood of having articular cartilage damage for the severe condition (16.25, 95% CI 9.9, 22.6), but only a minimal likelihood for ruling-in the disease for mild (1.35, 95% CI −5, 7.7) or moderate (1.38, 95% CI −5, 7.7) conditions. Having a negative test was suggestive of only a small or minimal decrease in ruling-out the disease for all conditions (0.67–0.36).ConclusionsMPT is only useful as a physical examination tool for identifying patellofemoral joint articular cartilage damage when the crepitation grade subclassification is severe.     

双能量CT对早期痛风性关节炎的诊断价值

目的探讨第二代双源双能量CT(DECT)对早期痛风性关节炎的诊断价值。方法收集我院46例早期痛风患者(GA组),及23例非痛风性关节炎患者(对照组)为研究对象,所有患者入院后均行双能量CT检查,回顾性分析其DECT影像资料,有尿酸盐沉积为阳性,无尿酸盐沉积为阴性,采用SPSS软件独立样本χ²检验对2组尿酸盐沉积进行对比研究,P<0.05视为有统计学意义。结果DECT对痛风结晶的阳性检出率比对照组高,差异有统计学意义(χ²=21.50,P=0.01)。双能量CT对早期痛风诊断的特异度95.65%(22/23),敏感度为63.04%(29/46);假阳性率为4.35%(1/23),假阴性率为36.96%(17/46),阳性预测值为96.67(29/30),阴性预测值为56.41(22/39);早期痛风组与临床诊断标准对比绘制ROC曲线,ROC曲线下面积(AUC)为0.80,标准误为0.05,95%CI(0.71,0.91)。结论DECT对于痛风患者的早期诊断价值中等,具有一定的诊断价值。