颅内感染性疾病脑脊液中肿瘤坏死因子-α、免疫球蛋白及腺苷脱氨酶检测的临床意义

目的 探讨脑脊液中TNF-α、免疫球蛋白(Ig)、腺苷脱氨酶(ADA)在颅内感染患者脑脊液中的变化及临床意义.方法 分别用ELISA法、免疫速率散射比浊法及酶耦联法检测25例化脓性脑膜炎(化脑组)、30例结核性脑膜炎(结脑组)、28例病毒性脑膜炎(病脑组)患者的脑脊液中TNF-α、Ig成分和ADA的含量,并与对照组(24例)进行比较.结果 结脑组脑脊液中IgA为(41.72±11.31)mg/L、Igm为(18.11±2.62)mg/L、IgG为(181.60±41.19)mg/L,ADA为(13.41±3.42)U/L、TNF-α/;为(418.62±43.16)ng/L;化脑组脑脊液中IgA为(20.65±8.85)mg/L、IgM为(93.20±4.30)mg/L、IgG为(92.77±35.09)mg/L、ADA为(3.32±2.41)U/L、TNF-α为(476.93±45.16)mg/L;病脑组脑脊液中IgA为(7.11±2.23)mg/L、IgM为(5.81±1.19)mg/L、IgG(20.71±10.54)mg/L、ADA为(2.36±0.44)U/L、TNF-α为(375.06±45.21)ng/L,结脑组与化脑组脑脊液中IgM、IgG、IgA含量均较病脑组、对照组显著增高(P<0.01),其中结脑组以IgG、IgA升高最明显,化脑组以IgM升高最明显;结脑组脑脊液中ADA活性与对照组和其他两组比较明显增高(P<0.01);化脑组ADA较对照作者单位:266043青岛市胸科医院胸五科组和病脑组升高(P<0.05).脑脊液中TNF-α在化脑组最高,结脑组次之,与对照组比较差异均有统计学意义;病脑组与对照组比较,除TNF-α外,各项指标差异均无统计学意义(P均0.05).结论 脑脊液中ADA活性测定对结核性脑膜炎的诊断意义最大.同步检测脑脊液中TNF-α、Ig、ADA对颅内感染性疾病的诊断及鉴别诊断可能具有更好的临床应用前景.

Clinical significance of detecting tumour necrosis factor-α, immtme globnlin and adenosine deaminase in cerebrospinal fluid of patients with intracranial infection

Objective To investigate the diversify and clinical significance of tumour necrosis factor-alpha (TNF-α), immune globulin (Ig), adenosine deaminase (ADA) in cercbrospinal fluid (CSF) of patients with intracranial infection. Method The levels of TNF-α,Ig and ADA in CSF of 25 cases of purulent meningitis ,30 eases of cerebral tuberculosis ,28 cases of virus meningitis and 24 cases of controls were detected by ELISA, immunity velocity scattering nepbelometry and enzyme coupling method respectively. Results The levels of IgA, IgM, IgG, ADA, TNF-α were (41.72±11.31) mg/L(18.11± 2.62)mg/L, (181.60±41.19)mg/L, (13.41±3.42)U/L, (418.62±43.16)ng/L in cerebral tuberculosis patients. The levels of IgA, IgM, IgG, ADA and TNF-αwere (20.65±8.85)mg/L, (93.20±4.30)mg/L, (92.77±35.09)mg/L, (3.32±2.41) U/L, (476.93±45.16) ng/L in purulent meningitis patients, and those were (7.11±2.23)rag/L,(5.81±1.19)mg/L,(20.71±10. 54)mg/L,(2. 36±0. 44)U/L,(375.06±45.21) ng/L in virus meningitis patients. The levels of IgM,IgG and IgA in cerebral tuberculosis patients and purulent meningitis patients were significantly higher than those in virus meningitis patients and controls (P< 0.01). The levels of IgG,IgA heightened most markedly in cerebral tuberculosis patients. The activity of ADA in cerebra] tuberculosis patients was higher markedly than that in controls and the other patients(P< 0.01). The levels of TNF-α in purulent meningitis patients were higher than those in controls and virus meningitis patients(P< 0.05). The levels of TNF-α in purulent meningitis patients were the highest, and the next was in cerebral tuberculosis patients. But there was no significant difference of each index between viral meningitis patients and controls. Conclusions Detecting the activity of ADA in CSF is the most valuable in diagnosing cerebral tuberculosis. Synchronized detection of TNF-α,Ig, ADA may be have better clinical application in diagnosing intracranial infection.