脑脊液/血浆中的腺苷脱氨酶比值对鉴别结核性脑膜炎与化脓性脑膜炎作用分析

目的 探讨脑脊液(CSF)/血浆中的腺苷脱氨酶(ADA)比值在鉴别结核性脑膜炎和化脓性脑膜炎中的价值.方法 选取结核性脑膜炎患者62例,化脓性脑膜炎患者80例,检测患者静脉血及CSF中糖、蛋白、ADA和氯化物含量.结果 结核性脑膜炎患者CSF和血浆ADA分别为(10.21 ±4.33)U·mL-1和(15.04±6.21)U·mL-1,明显高于化脓性脑膜炎(P＜0.05);结核性脑膜炎患者CSF和血浆氯化物为(101.22±10.73) mmol·L-1和(97.20 ± 6.07) mmol·L-,明显低于化脓性脑膜炎(P＜0.05);结核性脑膜炎血浆蛋白为(60.51±5.78)g·L-1,明显低于化脓性脑膜炎(P＜0.05);结核性脑膜炎患者CSF与血浆蛋白比值、ADA比值分别为(0.023±0.007)和(0.691±0.121),均高于化脓性脑膜炎,而氯化物比值为(1.041±0.160),低于化脓性脑膜炎(P ＜0.05);CSF/血浆ADA比值诊断结核性脑膜炎的ROC曲线下面积为0.890(P＜0.05),截断值为0.552时,灵敏度和特异度分别为91.90％和90.00％;CSF/血浆氯化物比值诊断结核性脑膜炎的ROC曲线下面积为0.663(P ＜0.05),截断值为1.086时,灵敏度和特异度分别为65.00％和64.52％.结论 CSF/血浆中的ADA比值在诊断结核性脑膜炎诊断中有较高的意义,有助于临床医生鉴别诊断.

Values of CSF/plasma ADA in the diagnosis of tuberculous meningitis and purulent meningitis

Objective To investigate values of cerebrospinal fluid (CSF) /plasma adenosine deaminase (ADA) in the differential diagnosis of tuberculous meningitis and purulent meningitis.Methods Sixty-two cases of tuberculous meningitis and 80 cases of purulent meningitis were selected to detect sugar,protein,ADA and chloride content in venous blood and CSF.Results CSF and plasma ADA in patients with tuberculous meningitis were (10.21 ± 4.33) U · mL-1 and (15.04 ± 6.21) U · mL-1,respectively,which were significantly higher than those of purulent meningitis patients (P ＜ 0.05).CSF and plasma chloride in tuberculous meningitis patients were (101.22 ± 10.73) mmol · L-1 and (97.20 ± 6.07) mmol · L-1,respectively,which were significantly lower than those in purulent meningitis patients (P ＜ 0.05).The plasma protein of tuberculous meningitis patients was (60.51 ± 5.78) g · L-1,which was significantly lower than that of purulent meningitis patients (P ＜ 0.05).Tuberculous meningitis CSF and plasma protein ratio and ADA ratio were (0.023 ± 0.007) and (0.691 ± 0.121),respectively,which were both higher than those of purulent meningitis,while chloride ratio was (1.041 ± 0.160),which was lower than that of purulent meningitis (P ＜ 0.05).The area under the ROC curve of CSF/plasma ADA ratio in the diagnosis of tuberculous meningitis was 0.890 (P ＜ 0.05) and when the cut-off value was 0.552,the sensitivity and specificity were 91.90％ and 90.00％,respectively.The area under the ROC curve of CSF/plasma chloride ratio in the diagnosis of tuberculous meningitis was 0.663 (P ＜0.05) and when the cut-off value was 1.086,the sensitivity and specificity were 65.00％ and 64.52％,respectively.Conclusions CSF/plasma ADA ratio in the diagnosis of tuberculous meningitis is of great significance,which helps clinicians to identify the diagnosis.