脑脊液检测对结核性脑膜炎诊断的意义

 目的 评估3种脑脊液检测方法对结核性脑膜炎(简称结脑)诊断的价值.方法 将150 例住院患者分为2组,其中结核性脑膜炎组(结脑组)73例,对照组77例.所有患者均进行脑脊液细胞学检查(简称细胞学),腺苷脱氨酶检测(简称ADA法)和脑脊液单核细胞内结核抗原(简称抗原法)的检测.结果 细胞学检测显示,结脑组混合性细胞学反应占82.2%,对照组仅27.2%,有统计学差异.ADA法的敏感性为89%,特异性80.5%,阳性预测值81.2%,阴性预测值91.2%.抗原法的敏感性84.9%,特异性100%,阳性预测值100%,阴性预测值87.5%.结论 抗原法的特异性和阳性预测值最好,联合检测对诊断的价值更大.

Significance of detection of CSF in diagnosis of tuberculous meningitis

Objective To evaluate three methods of detecting CSF in the diagnosis of tuberculous meningitis. Methods 150 patients were divided into two groups ： the group consisting of 73 patients of tuberculous meningitis, and control group, with 77 patients. All the patients underwent CSF, including the routine test, biochemistry, cytology （ MGG dye）, adenosine deaminase （ADA） test, and immunofluorescence demonstration of mycobacterial antigens in the cytoplasm of monocytes at the same time. Results Cytology of TBM group showed a mixed cell response in CSF, with a positive rate of 82.2% which control group had a positive rate of 27.2%. The sensitivity of ADA test was 89% ,the specificity 80.5% , positive predictive value 81.2%, and negative predictive value 91.2%. Detected antigens in monocytes showed a sensitivity of 84.9%, but they were all negative in the control group. The specificity was 100%, positive predictive value 100%, and negative predictive value 87.5%. Conclusions The specificity and positive predictive value of demonstration of mycobacterial antigens in the cytoplasm of monocytes are the best among the three methods and diagnosis may be improved by combining several tests.