聚合酶链反应和酶联免疫吸附试验早期诊断结核性脑膜炎的对比研究

Comparative study of early diagnosis of tuberculous meningitis by polymerase chain reaction and enzyme-linked immunosorbent assay.

为早期诊断结核性脑膜炎，采用聚合酶链反应检测５６例结脑患者脑脊液中结核杆菌ＤＮＡ．并与细菌学检查和酶联免疫吸附试验比较，三种方法的敏感性和特异性分别为８２％和１００％，２３．２％和１００％，６６％和９２．８％．５６例结脑中病程６～１５天１８例，ＰＣＲ和ＢＡ－ＥＬＩＳＡ阳性率分别为８８．８％和３８．８％（Ｐ＜０．０２５）。４２例对照组中，ＰＣＲ均为阴性，ＢＡ－ＥＬＩＳＡ３例阳性。表明ＰＣＲ是临床早期诊断结脑最敏感和特异的方法，ＰＣＲ和ＢＡ－ＥＬＩＳＡ同时检测将会提高结脑诊断的阳性率。

AbstractFor the sake of early diagnosis of Tuberculous meningitis(TBM)56 cases were studied by i-dentification of the genomic DNA of M. tuberculosis in cerebrospinal fluid(CSF)by the poly-merase chain reaction(PCR),comparing with conventional CSF bacteriological evaluation as well as biotin-avidin enzvme-linked immunosorbent aasey(BA-ELISA)for specific antibodies. All cases had been diagnosed according to clinical criteria. The sensitivity and specificity of the three tests were 82%and 100%(PCR);23.2%and 100%(Culture);66%and 92.8%(BA-ELISA),re-spectively.In a group of 18 cases between 6-15 days,PCR was positive in 16 cases(88.8%)and BA-ELISA in 7 cases(38.8%)(P<0.025).None of the specimens in 42 cases of control group was positive by PCR,but BA-ELISA was positive in 3 controls despite the use of a high cutoff val- ue. It was sugggested that PCR would be the most sensitive and specific method in the early diagno-sis of TBM and the positive rate will increase by combining PCR and BA- ELISA.