T-SPOT.TB在结核性脑膜炎早期诊断中的价值

目的探讨T-SPOT.TB在结核性脑膜炎早期诊断中的价值,为结核性脑膜炎的早期诊断提供有效检查方法。方法选择结核性脑膜炎40例(患者组)及非结核性脑膜炎感染66例(对照组)进行T-SPOT.TB检测,进一步比较多种检查方法诊断结核性脑膜炎的敏感性和特异性。结果脑脊液T-SPOT.TB实验显示,结核性脑膜炎组阳性检出率为95%(38/40),非结核性颅内感染组为3.03%(2/66);外周血T-SPOT.TB实验显示,结核性脑膜炎组阳性检出率为72.5%(29/40),非结核性颅内感染组为13.64%(9/66),均高于脑脊液抗酸染色涂片、结核菌培养、荧光定量PCR、结核抗体检测等方法,且具有较高的特异性。外周血T-SPOT.TB实验阳性检出率与脑脊液阳性检出率比较,差异无统计学意义(Fisher确切概率法,P=0.254)。结论运用T-SPOT.TB实验检测外周血和脑脊液单个核细胞结核杆菌感染的阳性率高于其他方法,明显提高了结核性脑膜炎的诊断率,采用T-SPOT.TB实验检测脑脊液诊断结核性脑膜炎阳性率高于外周血检测的阳性率。     

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 。     

结核蛋白芯片检测脑脊液中抗体对结核性脑膜炎诊断价值

目的探讨结核分枝杆菌蛋白芯片检测脑脊液中结核抗体诊断结核性脑膜炎的应用价值。方法应用结核蛋白芯片检测30例临床诊断结核性脑膜炎患者脑脊液及血清标本,30例非结核性脑膜炎患者脑脊液标本,并对实验结果进行分析评价。结果结核芯片法检测脑脊液敏感性、特异性、阳性预测值、阴性预测值、约登指数分别为63.33%、96.67%、95.00%、72.50%、60.00%,结核芯片法检测血清性为66.67%。比较结脑组脑脊液及血清阳性率,差异无统计学意义(χ2=0.073,P=0.787,P>0.05)。结论结核蛋白芯片检测脑脊液可以成为结核性脑膜炎诊断的辅助检查,且具有快速、简便、经济等优点。     

酶联免疫斑点法和IS6110聚合酶链反应在早期诊断结核性脑膜炎中的价值

目的 探索一种敏感而特异的早期诊断结核性脑膜炎(TBM)的方法.方法 对25例TBM患者及作为对照的27例其他中枢神经系统感染性疾病患者、22例非感染性其他神经系统疾病患者同时应用酶联免疫斑点法(ELISPOT)检测脑脊液和外周血中的抗卡介苗(BCG)抗体分泌细胞数,应用PCR检测脑脊液中结核杆菌DNA的特异性重复插入片段IS6110,用酶联免疫吸附法(EUSA)检测脑脊液和外周血抗BCG抗体.结果 ELISPOT的敏感性(84.0%)明显高于IS6110PCR(75.0%)及ELISA(52.3%),三者的特异性分别为91.8%、93.7%和91.7%.TBM患者脑脊液抗BCG-IgG分泌细胞的个数在疾病早期最高,随病程的延长逐渐下降(t=-3.183,P=0.008).结论 ELISPOT对早期诊断TBM有一定的价值.     

激光扫描共聚焦显微镜技术检测脑脊液单核细胞早期分泌抗原靶-6在结核性脑膜炎早期诊断中的应用

目的探讨激光扫描共聚焦显微镜(LSCM)技术检测脑脊液单核细胞早期分泌抗原靶-6(ESAT-6)在结核性脑膜炎早期诊断中的应用价值,为早期诊断寻找一种更特异性的检测方法。方法采用免疫荧光双标法检测ESAT-6抗原,LSCM观察脑脊液单核细胞着色情况(ESAT-6阳性细胞胞核呈蓝色荧光、胞质呈红色荧光,ESAT-6阴性细胞胞核呈蓝色荧光、胞质不着色)并分析三维成像结果。结果ESAT-6抗原主要表达于结核性脑膜炎患者脑脊液单核细胞胞质,呈红色荧光。结核性脑膜炎组有28例(80%)ESAT-6阳性、对照组仅1例(2.86%)阳性,组间差异具有统计学意义(χ2=42.918,P=0.000);ESAT-6检测灵敏度80%,特异度97.14%。结论 ESAT-6抗原检测可为结核性脑膜炎的早期诊断提供一定依据,且特异性较高。LSCM技术可实现多重荧光同时观察并形成清晰的断层扫描和三维图像,把细胞学研究提高到新水平。     

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。     

脑脊液CFP-10和Ag85检测对结核性脑膜炎的诊断价值

研究背景结核性脑膜炎的早期诊断目前仍是临床难点,寻找结核性脑膜炎早期特异性诊断指标是目前研究热点。本文主要探讨脑脊液培养分泌蛋白10(CFP10)和Ag85蛋白复合物表达水平对结核性脑膜炎的临床诊断价值。方法采用酶联免疫吸附试验分别检测结核性脑膜炎(30例)、非结核性颅内感染(27例)和对照(29例)受试者脑脊液CFP10和Ag85蛋白复合物表达水平。结果结核性脑膜炎组患者脑脊液CFP10和Ag85中位表达水平分别为0.74和1.10pg/ml,均高于非结核性颅内感染组[(0.02±0.01)、(0.54±0.10)pg/ml]和对照组[(0.02±0.01)、(0.52±0.11)pg/ml],组间差异有统计学意义(H=60.958,P=0.000;H=57.972,P=0.000)。非结核性颅内感染组与对照组之间差异无统计学意义(t=1.128,P=0.253;t=0.980,P=0.329)。结论结核性脑膜炎患者脑脊液CFP10和Ag85蛋白复合物表达水平高于非结核性颅内感染患者和对照者,检测这两项实验室指标的变化可协助结核性脑膜炎的早期诊断。     

37例培养阳性结核性脑膜脑炎脑脊液细胞学动态分析

目的探讨脑脊液结核分枝杆菌培养阳性结核性脑膜炎脑脊液细胞学特点。方法运用玻片细胞沉淀(粟秀初教授研制)细胞学方法,对37例使用Bactec MGIT 960培养阳性结核性脑膜炎患者的脑脊液细胞学分类特点进行动态观察与分析。结果结核性脑膜脑炎患者脑脊液白细胞总数升高,但有4例患者脑脊液白细胞数小于50×106/L。多数确诊结核性脑膜炎患者脑脊液呈混合型细胞反应,有33例(89.2%)患者脑脊液中检测到中性粒细胞,25例(67.6%)患者脑脊液中检测到浆细胞。但多数患者脑脊液(60%)以淋巴细胞为主,少量(1/3)以中性粒细胞为主。且几乎所有患者脑脊液内均可以检测到浆细胞的存在。结论确诊结核性脑膜炎患者的脑脊液白细胞数明显增高,脑脊液细胞分类主要表现为淋巴细胞为主型,少部分为中性粒细胞为主型。     

结核性脑膜炎临床及脑脊液细胞学分析

目的分析结核性脑膜炎患者临床表现、早期脑脊液细胞学改变及演变过程,提高对其早期识别能力及诊疗效果的判断。方法回顾分析60例结核性脑膜炎患者的临床特征、病原学检查及脑脊液生化尤其是细胞学动态变化资料。结果 60例患者中58例(96.67%)以发热、头痛发病,1周内并发意识障碍者9例(15.00%),伴抽搐5例(8.33%)、眼动障碍8例(13.33%)、偏瘫7例(11.67%),44例(73.33%)既往有肺结核病史。实验室检查脑脊液浓缩集菌抗酸染色阳性8例(13.33%)、结核分枝杆菌培养阳性5例(8.62%)、脑脊液结核分枝杆菌DNA阳性5例(8.77%)。脑脊液改变以颅内压、蛋白定量升高、葡萄糖降低为主;细胞学变化呈现以淋巴细胞增多为主的混合细胞学反应,发病早期脑脊液中性粒细胞比例<0.40,经抗结核药物治疗后细胞总数及中性粒细胞比例短期内(最长随访2个月)可无明显改变。经正规抗结核药物治疗,44例患者好转、11例迁延不愈并出院或转院、5例死亡;发病3周内接受抗结核药物治疗的患者预后明显优于发病3周后接受治疗者。结论结核性脑膜炎患者临床表现无特异性,病原学阳性检出率极低,早期诊断困难。肺结核病变对明确诊断具有辅助价值,脑脊液混合细胞学反应可高度提示诊断。经抗结核药物治疗后脑脊液细胞学演变缓慢,可长期呈混合细胞学反应,不能以此为据推翻结核性脑膜炎的诊断。治疗时机很大程度上决定治疗效果。     

不明原因的颅内感染与博尔纳病病毒感染的研究

目的分别检测不明原因的颅内感染患者外周血单个核细胞(PBMCs)和脑脊液有核细胞(CSFMCs)中博尔纳病病毒(BDV)p24基因,探讨不明原因颅内感染患者与BDV感染的关系及阳性患者的临床特征。方法用荧光定量巢式逆转录聚合酶链反应(FQ-nRT-PCR)方法检测不明原因颅内感染患者及对照者PBMCs或CSFMCs中BDV p24基因片段,同时用β-肌动蛋白(-βactin)作为内参照,并总结阳性患者的临床特征。结果PBMCs中BDV p24基因片段检测结果显示,实验组7例阳性,对照组均为阴性,差异有统计学意义(P<0.05)。实验组进行CSF检查的32例颅内感染患者中4例外周血和CSF标本BDV p24基因片段检测均为阳性,阳性基因片段产物测序后与BDV标准病毒株V和马源的BDV病毒株H1766序列比较,结果同源性分别为95.35%和98.84%,在4个位点出现基因突变(nt1649 T→C,nt1656 G→A,nt1670 C→T,nt1676 C→T);7例BDV p24基因片段阳性患者主要以精神行为异常为起病方式,患者与动物关系密切,其他临床特征无特殊。结论贵州省遵义市部分不明原因颅内感染的发生与BDV感染有关,主要以精神行为异常为临床特征。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.