脑脊液检测在结核性脑膜炎早期诊断中的研究进展

结核性脑膜炎(tuberculous meningitis,TBM)是肺外结核中最严重的临床表现类型,具有较高的病死率及致残率,故早期、快速诊断及鉴别诊断TBM对疾病的治疗和预后至关重要。笔者通过综述近年来脑脊液(cerebrospinal fluid,CSF)检测在TBM早期诊断及与化脓性脑膜炎、病毒性脑膜炎(viral meningitis,VM)和新型隐球菌性脑膜炎(cryptococcul neoformans meningitis,CNM)的鉴别诊断方法,旨在为TBM的早期诊断与鉴别诊断提供一定的诊疗思路。     

CSF检测在SLE并发狼疮脑病、结核性脑膜炎鉴别诊断的意义

目的评价脑脊液(CSF)检测在系统性红斑狼疮(SLE)并发狼疮脑病(NPLE)和结核性脑膜炎(TBM)鉴别诊断中的价值。方法对16例SLE并发NPLE患者及16例SLE并发TBM患者CSF进行检测并分析。结果两组患者的CSF在压力、白细胞、蛋白质、葡萄糖、氯化物、腺苷脱氨酶(ADA)、C反应蛋白(CRP)、抗酸杆菌培养方面有显著性差异(P0.05)。结论CSF检测在SLE并发NPLE与SLE并发TBM的鉴别诊断意义较大。     

脑脊液结核分枝杆菌阳性的结核性脑膜炎32例临床分析

结核性脑膜炎(tuberculosis meningitis,TBM)是最严重的结核病,病死率高,后遗症严重[1],早期诊断是改善预后的关键.TBM诊断的金标准仍是脑脊液(CSF)涂片或培养分离出结核分枝杆菌[2].本研究回顾性分析32例脑脊液结核分枝杆菌阳性的TBM患者资料,探讨其临床特点,以期能提高TBM的诊断率,减少误诊、漏诊,改善患者的预后.     

一例耐多药结核性脑膜脑炎患者的诊治过程并文献复习

<正>结核性脑膜炎(TBM)是最严重的肺外结核类型,且随着耐药结核病在全球范围内的流行,耐药及耐多药结核性脑膜炎(MDR-TBM)患者也有增多趋势。因脑脊液(CSF)细菌学检查阳性率低,早期耐药TBM的诊断较为困难;且因血脑屏障及药物通透性的影响,耐药TBM的治疗与耐药肺结核相比在药物选择上也有其特殊性。因此,耐药TBM在诊治方面较耐多药肺结核有更多的诊断和治疗难点。笔者对     

造影剂肾病早期诊断的生物标志物

随着造影剂在临床的广泛使用,造影剂肾病(CIN)已成为院内获得性急性肾损伤(AKI)的常见病因。早期诊断CIN可指导及时有效地治疗进而改善患者预后。有可能早期诊断CIN的生物标志物包括胱抑素C、中性粒细胞明胶酶相关载脂蛋白、白细胞介素18、肾损伤分子1、肝脏型脂肪酸结合蛋白等。本文对近年来临床工作和基础研究中被人们所关注的各种CIN早期诊断生物标志物做一综述,通过横向对比,进一步探讨适合用于CIN早期诊断的生物标志物。     

结缔组织病相关间质性肺病血清生物标志物的研究进展

间质性肺病(ILD)是结缔组织病(CTD)最常见和最严重的并发症之一, 极大地影响患者的预后及生存率。早期诊断、准确分类和密切监测对有效管理CTD相关ILD患者至关重要。近年来国内外大量研究表明, CTD相关ILD患者血清生物标志物对疾病诊断、风险分层、预后评估等方面具有重要意义。本文对CTD相关ILD血清生物标志物(自身抗体、肺泡上皮损伤标志物、细胞因子、肿瘤标志物等)的研究进展进行系统综述。     

肿瘤标志物在部分消化道肿瘤诊断中的研究进展

在中国,消化道肿瘤的发病率持续升高,探索早期诊断的有效方法对改善患者预后至关重要.生物标志物可用于辅助诊断消化道肿瘤,对高危人群进行无创性肿瘤标志物筛查,可减少影像学检查和胃肠镜检查的人数,并可提高患者对筛查的依从性,为治疗争取时间.该文主要对用于肝细胞癌(HCC)、结直肠癌(CRC)诊断的生物标志物,包括miRNA、...     

结核性脑膜炎患者行脑脊液实验室检测方法的现状与进展

结核性脑膜炎(tuberculous meningitis,TBM)是最常见的肺外结核之一,约占全部结核病患者的1%;但死亡率可达26.8%,死亡多发生在患病最初的6个月,早期诊断及治疗是改善TBM预后的重要因素。临床上对TBM的诊断是通过临床表现、脑脊液检测、头颅影像学检查及是否并发颅外结核等综合分析后作出的。脑脊液检测是诊断TBM的重要指标,通过检测脑脊液中的结核分枝杆菌及其特异性的标志物,可以为TBM的诊断提供重要帮助。     

结核性脑膜炎的诊断标准及其验证

结核性脑膜炎(TBM)是慢性脑膜炎的最常见类型,发病率与死亡率很高。唯一可靠的诊断方法是证实脑脊液(CSF)中存在结核杆菌,但费时,且检出率低。早期诊断和治疗对预后至关重要。为明确而易于表达诊断,作者利用临床特征、CSF检查、CT发现以及神经系统以外的结核证据等条件设计了一套诊断标准,并以76例病人为对象,经PCR检查,细菌分离,病理学检查,H·R·Z正规化疗并随访3个月,观察症状改善情况等,检验该标准的可靠性。     

类风湿关节炎相关肺间质病变生物标志物

肺间质病变(ILD)是类风湿关节炎(RA)最常见的关节外表现,死亡率和发病率较高.目前,RA-ILD的诊断基于患者临床表现和影像学检查,但缺乏有效的生物标志物.本文对近年来RA-ILD生物标志物的研究进行综述,寻找与RA-ILD早期诊断,预后评估以及致病机制相关的基因和自身抗体,为临床上诊断RA-ILD提供新思路.     

Efficiency of polymerase chain reaction for the diagnosis of tuberculous meningitis

The early diagnosis of tuberculous meningitis (TBM) is very important. In this study, the efficiency of the polymerase chain reaction (PCR), one of the most reliable and sensitive DNA-based assays, was compared with conventional methods (acid-fast microscopy and culture) for the detection of M. tuberculosis in cerebrospinal fluid(CSF) specimens from patients suspected of TBM. Of the 29 CSF specimens from highly-probable TBM patients (based on clinical features), 25 were positive by PCR (86.2%), whereas only one of 29 was acid-fast microscopy (AFM) positive (3.4%), and 5 out of 29 were culture-positive (17.2%). No positive results were found by AFM, culture or PCR in the non-tuberculous control group. The results of this study indicate that the application of PCR should be extremely useful in the diagnosis of TBM.     

结核性脑膜炎的临床早期诊断特征探索

目的通过比较结核性脑膜炎和急性细菌性脑膜炎患者的临床特征和实验室指标,探索结核性脑膜炎的早期诊断方法。方法对2005年1月—2014年5月住院确诊的173例结核性脑膜炎和87例急性细菌性脑膜炎患者的临床特征和实验室指标进行回顾性分析,采用logistic回归分析筛选与诊断相关的影响因素,并采用ROC曲线求诊断界值,建立结核性脑膜炎早期诊断模型。结果结核性脑膜炎早期诊断的相关因素包括：头痛时间≥6 d、外周血WBC计数〈14×109/L、脑脊液（cerebrospinal fluid,CSF）WBC计数〈600×106/L、CSF中性粒细胞比例〈0.75。用这4个指标建立的结核性脑膜炎早期诊断模型对应的ROC曲线下面积为0.999（95%CI：0.998-1.000）,具有较高的诊断价值。通过回代法进行验证,模型的误判率为1.15%,低于Thwaites模型的误判率（8.85%）。结论本研究建立的结核性脑膜炎诊断模型具有较高的诊断价值,诊断符合率较高,值得进一步进行临床验证与应用。     

31例非典型结核性脑膜炎临床疗效观察

目的总结非典型结核性脑膜炎（结脑）的诊断方法,提高临床认识,避免误诊,及早治疗。方法结合临床表现、脑脊液、影像学检查以及免疫学,回顾性分析31例非典型结脑临床资料。结果 31例患者经临床表现、脑脊液、影像学及免疫学,临床诊断结脑,给予诊断性抗结核治疗,30例恢复正常好转出院,1例自动出院。结论对非典型结脑的患者应反复行脑脊液及头部核磁共振检查。排除其他颅内感染性病变,尽早做诊断性抗结核治疗,避免病情加重减少并发症的发生。     

Diagnosing tuberculous meningitis – have we made any progress?

Tuberculous meningitis (TBM) comprises a significant proportion of TB cases globally and causes substantial morbidity and mortality, especially in children and HIV‐infected patients. It is a challenging condition to diagnose due to its non‐specific clinical presentation and the limited sensitivity of existing laboratory techniques. Smear microscopy and culture are the most widely available diagnostic tools yet are negative in a significant proportion of TBM cases. Simplified and more affordable nucleic acid amplification tests (NAATs) are increasing in use in resource‐limited settings but have not been optimised for cerebrospinal fluid (CSF) samples. Novel diagnostic methods such as CSF interferon‐gamma release assays and various biomarkers have been developed but require further evaluation to establish their utility as diagnostic tools. There is an urgent need for further research into optimal diagnostic strategies to decrease the morbidity and mortality as a result of delayed or missed diagnosis of TBM. In this review, we discuss current and novel diagnostic tests in TBM and areas where future research should be prioritised.     

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??Abstract??Objective To investigate the applicability of Hristea diagnostic scoring in differentiated diagnosis between viral meningitis (VM) and tuberculous meningitis (TBM).Methods The study was performed retrospectively in resident patients with TBM (n=87) or VM (n=76) in our hospital.The prediction of TBM was determined by Hristea diagnostic scoring using parameters such as duration of symptoms before admission??neurological stages??cerebrospinal fluid (CSF)/blood glucose ratio and CSF protein concentrations.The diagnostic value of the scoring was assessed by calculating the area under the receiver operating characteristic (ROC) curves.Results The Hristea scores of all parameters were significantly different between TBM and VM patients.The sensitivity??specificity??positive predictive value and negative predictive value of Hristea scoring for TBM were 89.7%??86.8%??88.6% and 88.0%??respectively.The area under the ROC curve value for the diagnostic scoring was 0.92.Conclusion Hristea diagnostic scoring is helpful in early diagnosis and differential diagnosis of TBM and VM??and the usefulness of the scoring should be validated in larger series.     

Rapid molecular diagnosis of tuberculous meningitis using the Gen-probe Amplified Mycobacterium Tuberculosis direct test in a large Canadian public health laboratory.

OBJECTIVE: A 5-year retrospective study of the performance of the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) for detecting Mycobacterium tuberculosis complex in cerebrospinal fluid (CSF). Patient data from culture-confirmed cases of tuberculous meningitis (TBM) were also analysed. RESULTS: In total, 311 CSF specimens were tested by the MTD, of which 17 were positive. When compared with culture (gold standard), the sensitivity and specificity of the MTD test were 93.8% and 99.3%, respectively. The positive and negative predictive values for TBM were 88.2%, and 99.7%. Clinical and epidemiological information was requested for all culture-positive TBM patients. These data were used to assess the mortality rate (55.6%) and to determine common factors that could be applied as selection criteria for the appropriate testing of CSF by MTD. CONCLUSION: The study found the MTD test to be a rapid, sensitive and specific test for TBM. A history of immigration from an area endemic for tuberculosis (TB), a history of TB, symptoms of neurological deficits and the results of CSF analyses could be used to appropriately select CSF for MTD testing in order to provide a critical early diagnosis of TBM.     

Detection and its clinical significance of IgM antibody in cerebrospinal fluid in patients with tuberculous meningitis

Specific antibody for IgM in cerebrospinal fluid (CSF) of 45 patients with tuberculous meningitis (TBM), 33 patients with non-TBM and 51 control patients was determined by enzyme-linked immunosorbent assay, and compared with specific antibody for IgG. The sensitivity and specificity was 71.1% and 98.8% for IgM antibody, and 88.9% and 96.4% for IgG antibody respectively, but the positive rate of IgM antibody at early stage of TBM was higher than that of IgG antibody. There was a highly significant positive correlation between positive rates of the two types of antibody and contents of protein in CSF. The sensitivity and specificity was 97.8% and 98.8% respectively in detecting both the IgM and IgG antibodies in CSF simultaneously, which can be used as a supplementary method for the diagnosis of TBM.     

三种快速检测技术诊断早期结核性脑膜炎的评价

目的 评价3种快速检测技术在早期结核性脑膜炎诊断中的应用价值。方法 采用离心涂片抗酸染色法、改良抗酸染色法、GeneXpert MTB/RIF技术(简称“GeneXpert技术”)对2016年8月至2018年6月河北省胸科医院和石家庄市第五医院收治的根据临床表现、影像学及实验室检查等临床确诊的45例结核性脑膜炎、42例非结核性脑膜炎患者的脑脊液标本进行分枝杆菌检测,并对结果进行分析。采用SPSS 19.0软件进行统计学分析,率的比较采用χ ²检验、校正χ ²检验,以P<0.05为差异有统计学意义。结果 以临床诊断为标准,45例结核性脑膜炎患者脑脊液分别应用离心涂片抗酸染色法、改良抗酸染色法、GeneXpert技术检测分枝杆菌的敏感度分别为4.44%(2/45)、88.89%(40/45)、35.56%(16/45);依次两两比较,差异均有统计学意义(χ ²值分别为64.46、13.16、27.23,P值均=0.000)。42例非结核性脑膜炎患者的脑脊液用离心涂片抗酸染色法、改良抗酸染色法、GeneXpert技术检测分枝杆菌均为阴性。3种检测技术检测分枝杆菌的特异度均为100.00%。结论 改良抗酸染色法较离心涂片法及GeneXpert技术检测分枝杆菌阳性率高,具有较好的确诊结核性脑膜炎的价值。     

The Prognostic Factors of Adult Tuberculous Meningitis

Background: Our aim was to analyze the prognostic factors and therapeutic outcomes of adult tuberculous meningitis (TBM). Patients and Methods: Clinical data of 36 patients with adult TBM were retrospectively identified at our institution over a period of 5 years. Results: 36 adult TBM patients, 23 males and 13 females, aged 16–83 years, were included in this study. The 36 patients were also divided into three groups (stages I, II and III) according to the severity of TBM on admission. Therapeutic outcomes at 3 months were determined using a modified Barthel Index (BI). For the purpose of statistical analysis, the patients were divided into two groups: good outcome (BI ≥ 12) and poor outcome (BI < 12). Positive cerebrospinal fluid (CSF) culture was found in 47% (17/36) of patients and isoniazid-resistant strains were found in 18% (3/17) of culture-proven TBM. We statistically compared clinical manifestations, CSF features and therapeutic results of the two patient groups. Significant prognostic factors included severity of TBM at the time of admission, the presence of headache, fever, hydrocephalus, high CSF protein concentration and high CSF lactate concentration. In stepwise logistic regression analysis, only the presence of hydrocephalus and severity of TBM on admission were strongly associated with therapeutic failure even after adjusting for other potentially confounding factors. Conclusion: In Taiwan, TBM is an important public health issue and the emergence of resistant strains of this disease in recent years presents a therapeutic challenge. Because delay in diagnosis is directly related to poor outcome, early diagnosis and early treatment are essential for survival. Received: July 17, 2000 · Revision accepted: July 16, 2001