检测脑脊液单核细胞内结核分支杆菌早期分泌性抗原对结核性脑膜炎的诊断价值

目的探讨脑脊液单核细胞内结核分支杆菌早期分泌性抗原（earlysecretoryantigenictarget6，ESAT-6）检测对结核性脑膜炎（tuberculousmeningitis，TBM）的诊断价值。方法选择我院2011年1月至2012年12月期间神经内科收治的经结核性脑膜炎诊断金标准确诊的46例TBM患者（结核性脑膜炎组）和40例非TBM患者（对照组）为研究对象，对两组患者的脑脊液分别行细胞学和生化检查，并检测患者脑脊液单核细胞内的ESAT-6抗原。结果结脑组患者脑脊液细胞100％呈混合性细胞学反应，对照组患者45％呈混合性细胞学反应，差异具有统计学意义（，=5．72，P〈0．05）；白细胞计数、葡萄糖和氢化物计量结脑组患者明显高于对照组（P〈0．01），而脑脊液蛋白含量差异无统计学意义（P〉0．05）。ESAT-6抗原检测诊断TBM的灵敏度为91．30％，特异度92．5％，假阳性率7．5％，假阴性率8．70％，阳性预测值93．33％，阴性预测值90．24％％。结论脑脊液单核细胞内ESAT-6检测对TBM具有较高的诊断价值，该辅助诊断方法值得临床推广及应用。

Diagnostic value of detection of cerebrospinal fluid mononuclear celiESAT-6 for tuberculousmeningitis

Objective To explore the diagnostic value of mononuclear cells early secretary antigenic target 6 （ESAT-6） in ce- rebmspinal fluid for tuberculous meningitis （TBM）. Methods Forty-six patients with tuberculous meningitis（ TBM group）and 40 non- ＂IBM cases（ control group）diagnosed by gold standard from January 2011 to December 2011 treated in Department of Neurology in our hospital were selected as research objectives. Cerebrospinal fluid of the two groups of patients underwent cytological and biochemical ex- amiuation. At the same time,cerebrospinal fluid monouuclear cells ESAT-6 was also examined. Results 100% of cerebrospinal fluid samples showed a mixed cell reaction in the TBM group while only 45% in the control group（P 〈 0. 01 ）. Moreover,cerebrospinal fluid white blood cell count and levels of glucose and chlorides in the TBM group were significantly higher than that in the control group（P 〈 0. 01 ）. However, there was no significant difference in cerebrospinal fluid protein concentrations between the two groups. The sensitivity and specificity of cerebrospinal fluid ESAT-6 antigen test for diagnosis of tuberculous meningitis were 91.30% and 92. 5% ,respective- ly. The false positive rate was 7. 5%, and false negative rate was 8.70%. Positive predictive value was 93. 33%, and negative predictive value of 90. 24%. Conclusion Detection of cerebrospinal fluid mononuclear cells ESAT-6 test has a high diagnostic value for tuber- culous meningitis. Therefore, the auxiliary.diagnosis method is worthy of clinical application and popularization.