脑脊液T-SPOT检测在结核性脑膜炎诊断中的临床应用价值

目的 探讨脑脊液结核斑点试验(T-SPOT)检测在结核性脑膜炎临床诊断中的价值,为结核性脑膜炎早期快速诊断提供实验依据。方法 对兰州军区兰州总医院221例脑脊液标本进行筛查,实验组选取脑脊液淋巴细胞计数大于100×10⁶/L或者高度怀疑脑膜炎患者淋巴细胞计数大于50×10⁶/L的82例脑脊液标本进行T-SPOT实验检测,统计分析患者临床诊断、脑脊液检测指标、血清PCT结果,对照组选取100例非结核性脑膜炎患者进行ROC曲线分析。结果 脑脊液结核斑点试验检测在结核性脑膜炎患者中的阳性率为64.63%(53/82),敏感度为98.11%,特异度为100%; 结核性脑膜炎患者脑脊液淋巴细胞计数、脑脊液蛋白、脑脊液葡萄糖、脑脊液氯离子值和血清PCT的ROC曲线下面积(AUC)分别为0.996,0.965,0.109,0.061和0.392,且结核性脑膜炎患者脑脊液淋巴细胞计数和脑脊液蛋白的均值分别为323.88±198.76个/L,1 478.2±778.64 mg/L。结论 脑脊液结核斑点试验检测在结核性脑膜炎患者中具有较高的阳性率、敏感度和特异度,可用于结核性脑膜炎的早期快速诊断。

Clinical Application Value of CSF T-SPOT.TB Detection in Diagnosis of Tuberculous Meningitis

Objective To investigate the value of CSF T-SPOT.TB detection for the rapid early diagnosis of tuberculousmeningitis.Methods 80 cases of TBM intracranial infection in Lanzhou General Hospital of Lanzhou Millitary Region were selected if the count of CSF lymphocytes was larger than 100×10⁶/L or highly suspected patients with tuberculous meningitis lymphocyte counts were larger than 50×10⁶/L asthe observation group, and 100 cases control group patients' clinical diagnosis,CSF of lymphocytes numbers,protein,glucose,chlorideion and PCT of of the blood for the ROC curve analysis.Results This detection ofCSF by T-SPOT in tuberculous meningitis established a high positive rate was 64.63%(53/82),the sensitivity was 98.11% and the specificity was 100%.The CSF of lymphocytes number,protein,glucose,chlorideion and PCT of the blood underthe ROC curve area were 0.996,0.965,0.109,0.061 and 0.392 respectivelyin patients with tuberculous meningitis,and the average values of cerebrospinalfluid lymphocyte count and cerebrospinal fluid protein were 323.88±198.76 A/L,1 478.2±778.64 mg/L respectively.Conclusion Cerebrospinal fluid specimens detected by T-SPOT showed a high positive rate sensitivity and specificity in tuberculous meningitis,it may use early rapid diagnosisof tuberculous meningitis successfully.