运用PCR及ABC－ELISA法早期诊断结核性脑膜炎的评价

收集了４１例结核性脑膜炎（结脑）患者和３０例非结脑患者脑脊液，运用ＰＣＲ法扩增结核蛋白抗原Ｂ上ＤＮＡ序列４１９ｂｐ片段，用ＡＢＣ－ＥＬＩＳＡ检测抗结核蛋白抗体。结脑组ＰＣＲ阳性率７５．７％（３１／４１），抗结核抗体阳性率６３．５％（２６／４１）；对照组ＰＣＲ全部阳性，抗结核抗体阳性率１３．３％。ＰＣＲ阳性可在发病第２天查到且在治疗６个月时仍可见ＰＣＲ阳性。随病程延长抗体阳性率上升。运用ＰＣＲ及ＡＢＣ－ＥＬＩＳＡ法早期诊断结脑快速而敏感，两法同时应用可提高阳性率。     

运用PCR及ABC—ELISA法早期诊断结论性脑膜炎的评价

收集了４１例结核性脑膜炎（结脑）患者和３０例非结脑患者脑脊液，运用ＰＣＲ法扩增结核蛋白抗原Ｂ上ＤＮＡ序列４１９ｂｐ片段，用ＡＢＣ－ＥＬＩＳＡ检测抗结核蛋白抗体。结脑组ＰＣＲ阳性率７５．７％（３１／４１），抗结核抗体阳性率６３．５％（２６／４１）；对照组ＰＣＲ全部阳性，抗结核抗阳性率１３．３％。ＰＣＲ阳性可在发病第２天查到且在治疗６个月时仍可见ＰＣＲ阳性。随病程延长抗全阳性率上升。运用ＰＣＲ及ＡＢＣ     

结核性脑膜炎免疫乳胶试剂的研制及临床观察

本文采用自制免疫乳胶试剂对４５例结核性脑膜炎及３２例非结核性脑膜炎患者脑脊液进行了结核菌抗体检测，４５例结核性脑膜炎抗体检测４４例阳性，检测阳性率９７．８％，３２例非结核性脑膜炎抗体检测均为阴性，特异性１００％，首次提出了一项快速，敏感，特异，简便，易于推广的新诊断技术。     

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     

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。     

结核性脑膜炎临床特点 脑脊液及影像学表现的相关研究

目的探讨结核性脑膜炎的临床特点、脑脊液及影像学表现。方法收集我院2011-10-2015-10符合条件的结核性脑膜炎75例患者,分析其临床特点、脑脊液指标动态变及磁共振表现等特征。结果除常见的发热、头痛、呕吐等主诉外,30%患者以咳嗽、咳痰、气短等脑外结核症状首诊;79%患者仍被误诊为病毒性脑膜炎;TBM经抗结核治疗后,脑脊液氯化物率先恢复,其后为蛋白、葡萄糖、ADA,而颅压及细胞数恢复最慢;结核性脑膜炎脑实质及脑膜均可受累,头颅MRI平扫检查阳性率80%,增强扫描阳性率96.9%。结论结核性脑膜炎易误诊为病毒性脑膜炎;TBM为多器官疾病,临床上应积极寻找脑外结核部位;MRI可较早发现TBM特征性病灶,且阳性率较高;临床上怀疑TMB时应尽可能利用多种现代技术寻找脑脊液中抗酸杆菌,为结脑诊断提供病原学依据。     

结核性脑膜炎的脑脊液细胞学(附39例报告)

应用微型沉淀室法对39例结核性脑膜炎患者55份标本进行脑脊液细胞学检查,发现主要特点为嗜中性粒细胞为主的混合性细胞反应(74％)。多数标本见到淋巴样细胞(76.4％)和浆细胞(63.6％)。经抗结核治疗后的恢复期则见嗜中性粒细胞下降和免疫活性细胞上升。未经治疗者或不能治疗者嗜中性粒细胞不下降。提示脑脊液细胞学检查对结核性脑膜炎的诊断、鉴别诊断、病情转归以及疗效判断等有一定价值,同样也有助于对结核性脑膜炎患者中枢神经系统免疫反应的了解。     

透明质酸酶辅助治疗并发于结核性脑膜炎的脑蛛网膜炎

对结脑并发症的治疗,特别是对脑蛛网膜炎的治疗,仍然是一个未解决的问题.脑蛛网膜炎可引起脑积水、视交叉蛛网膜炎、颅神经麻痹、偏瘫或四肢瘫等.这一合并症在小儿尤为多见.并用抗结核药和类固醇来预防和治疗这一合并症但效果不佳.对脑积水仍是主要用脑室分流术治疗,但该手术的合并症较多.本文报告用透明质酸酶治疗15例并发于结核性脑膜炎的脑蛛网膜炎.A组,13例儿童,2例成人,11例伴有交通性脑积水,4例伴视交叉蛛网膜炎.同时期15例并发于结核性脑膜炎的交通性脑积水用脑室分流术治疗,作为B组.(14例儿童,1例成人).结核性脑膜炎并发脑蛛网膜炎的诊断依据是:①临床症状进行性加重或不见改善,②视力减退甚或失明,③头颅进行性增大,均经神经放     

40例结核性脑膜炎早期诊断方法探讨

目的：探讨结核性脑膜炎（TBM）患者早期诊断方法。方法：用结核杆菌PCR检测法以及ELISA法检测结核抗体两种方法综合诊断。结果：临床确诊结核性脑膜炎患者,脑脊液（CSF）结核杆菌PCR的阳性率达85％,结核抗体阳性率达80％。结核：结核抗体、结核杆菌PCR检测可以作为结核性脑膜炎患者确诊的重要指标。     

囊虫性脑膜炎(附63例临床分析)

目的 分析63例囊虫性脑膜炎的临床资料，以加强对此病的认识，提高临床医师病的诊断率。方法 选取囊虫性脑膜炎患者63例，对其起病形式、临床症状与体征、辅助检查等进行分析。结果 患者多生活在囊虫病高发地区（95％）；慢性或亚急性起病（95％）；表现为反复发作性头痛（60％），可伴有发热（27％）或痴呆（15％），脑膜刺激征阳性（63％）；血嗜酸性细胞增加（50％）；CSF以淋巴细胞为主（47％），蛋白可升高，囊虫抗体阳性；皮下结节活检被证实为囊虫；非脑囊虫病的典型影像学表现，可伴有脑积水（49％）。结论 囊虫性脑膜炎是一种少见浆液性脑膜炎，应与结核性脑膜炎、霉菌性脑膜炎、梅毒性脑膜炎及原发或继发的脑膜癌变等鉴别。     

脑脊液单核细胞内ESAT-6检测对结核性脑膜炎的诊断意义

目的评价检测脑脊液中单核细胞内的早期分泌性抗原靶6(ESAT-6)对结核性脑膜炎诊断的意义,为结核性脑膜炎的诊断提供有效的方法。方法将20例结核性脑膜炎患者与20例对照组患者进行脑脊液常规、生化、细胞学检查,同时用免疫组化的方法检测脑脊液单核细胞内的ESAT-6及PPD。结果结核性脑膜炎患者单核细胞内存在ESAT-6,在20例结核性脑膜炎患者中14例显示阳性,对照组中1例阳性,结核性脑膜炎组单核细胞内ESAT-6阳性检出率显著高于对照组,(P<0.05),该方法诊断结核性脑膜炎敏感性为70%,特异性为95%,约登指数0.65。结核性脑膜炎组单核细胞内PPD阳性检出率显著高于对照组,(P<0.05),敏感性为0.65,特异性为0.90,约登指数为0.55。结论检测脑脊液单核细胞中ESAT-6是诊断结核性脑膜炎的一种简便、特异的方法 。     

老年结核性脑膜炎27例脑脊液细胞学动态分析

目的了解老年结核性脑膜炎患者急性期和恢复期脑脊液(CSF)细胞学变化特点和应用价值。方法 27例老年结核性脑膜炎病人经临床和辅助检查确诊,所获脑脊液采用自然沉淀法收集细胞,经MGG染色后光学显微镜下行细胞分类计数。结果 53份CSF标本有3份结果阴性(5.6%),余50份CSF细胞学均有异常。急性发病期CSF白细胞多以免疫活性细胞为主,其中转化型淋巴细胞出现率最高(83.33%),恢复期吞噬细胞出现率上升明显,达到65.38%。急性和恢复期均以转化型淋巴细胞反应为主的混合型细胞反应占优势。结论 CSF细胞学可协助早期诊断老年结核性脑膜炎,并对病程监测,预后评估提供帮助。     

Clinical early diagnosis of tuberculous meningitis]

We examined 37 tuberculous meningitis, 30 active pulmonary tuberculosis, and 31 nontuberculous disease patient's CSF and serum antitubercular antibody IgG with polymerized OT as an antigen by the method of ELISA, respectively. It is shown that there is of a specificity to the diagnosis of tuberculous meningitis. We also reexamined the serum antitubercular antibody daily, as well as CSF antitubercular antibody, and CSF routine and biochemical indexes weekly for 16 tuberculous meningitis inpatients ill no more than five days. It was found that CSF antitubercular antibody became positive five days earlier than self serum antitubercular antibody, seven days earlier than typical tuberculous meningitis CSF. It is shown that the positive of the CSF antitubercular antibody may be used as the basis of the early diagnosis of tuberculous meningitis. Through antitubercular therapy and monthly re-examinations of the above indexes, it was found that CSF and serum antitubercular antibody became negative earlier than the recovery of CSF routine and biochemical indexes, and so the examination of CSF and serum antitubercular antibody has some reference value to determine curative effects and prognosis.     

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。     

脑脊液腺苷脱氨酶与血清5’-核苷酸酶在结核性脑膜炎诊断中的价值

目的探讨脑脊液腺苷脱氨酶(CSF-ADA)与血清5’-核苷酸酶(5’-NT)在结核性脑膜炎诊断与鉴别诊断中的价值。方法回顾性分析40例结核性脑膜炎患者(病例组)与36例病毒性脑膜炎患者(对照组)的一般资料、脑脊液、血液学及影像学检查结果,重点探讨CSF-ADA与血清5’-NT在结核性脑膜炎中的诊断价值。结果病例组CSF-ADA和血清5’-NT水平显著高于对照组(P<0.001)。根据CSF-ADA与血清5’-NT的接收者操作特性曲线(ROC),CSF-ADA>4.40 U/L或血清5’-NT>4.85 U/L被认为是诊断的阳性结果,显示出高的敏感性与特异性,CSF-ADA的敏感度为92.5%,特异度为89%;血清5’-NT的敏感度为95%,特异度为70%。当联合CSF-ADA与血清5’-NT诊断结核性脑膜炎,即CSF-ADA>4.40 U/L或(和)血清5’-NT>4.85 U/L,其敏感性最高,其灵敏度为97.5%,特异度为73.5%,阳性似然比(PLR)为3.68,阴性似然比(NLR)为0.03。结论在结核性脑膜炎的诊断中,CSF-ADA与血清5’-NT可以起到快速、简单、相对准确的诊断作用。当CSF-ADA或(和)血清5’-NT明显升高时,可尽早怀疑结核性脑膜炎,同时结合临床表现、其他脑脊液、血液学及影像学结果综合诊断。     

Neurological complications of miliary tuberculosis

Introduction

The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis.

Materials and methods

In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment.

Results

Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up.

Conclusion

A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.     

脑室-腹腔分流术治疗结核性脑膜炎并发脑积水

目的探讨脑室-腹腔分流术(VPS)治疗结核性脑膜炎(TBM)合并脑积水的效果。方法回顾性分析2004年1月至2010年7月行VPS治疗的15例TBM合并脑积水患者的临床资料。结果 15例患者全部行VPS,术后意识均好转、症状减轻,未发生结核性腹莫炎。术前抗结核治疗1月以上者10例,均无分流管堵塞发生;而另外5例抗结核治疗不足1月者,分流管堵塞者2例。脑脊液蛋白含量在0.5g/L以上者6例中2例堵管;脑脊液蛋白在0.5g/L以下的9例中,无堵管者。结论 VPS是治疗TBM并发脑积水的有效方法,术前最好能抗结核治疗1月以上。     

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.     

PCR DNA扩增、抗原、特异性抗体联合检测对结核性脑膜炎的诊断研究

应用多聚酶链反应技术（ＰＣＲ）体外扩增脑脊液中结核分枝杆菌ＤＮＡ，酶斑免疫结合技术检测结核杆菌蛋白抗原及ＡＢＣ－ＥＬＩＳＡ法检测相应抗体联合检测诊断结核性脑膜炎，阳性率分别为：８３．７％（３６／４３），７６．７％（３３／４３），７４．４％（３２／４３）。讨论三者间发病不同期的关系，三者有阳性交叉现象。