脑脊液中免疫球蛋白、乳酸脱氢酶及腺苷脱氨酶检测鉴别脑膜炎

Detection of immunoglobulins, lactate dehydrogenase and adenosine deaminase in cerebrospinal fluid for the differential diagnosis of three type meningitis

目的探讨脑脊液中免疫球蛋白(immunoglobulin,Ig)、乳酸脱氢酶(lactatedehydrogenase,LDH)及腺苷脱氨酶(adenosinedeaminase,ADA)对三种脑膜炎的鉴别诊断意义。方法检测结核性脑膜炎15例、化脓性脑膜炎18例、病毒性脑膜炎20例患者的脑脊液中LDH、ADA、Ig的含量,并与对照组进行比较。结果化脓性脑膜炎组脑脊液中LDH为(85.62±18.13)U/L、ADA为(2.58±0.52)U/L、IgM为(63.84±13.43)mg/L、IgG为(92.57±35.19)mg/L、IgA为(20.62±8.74)mg/L;结核性脑膜炎组LDH为(78.83±22.39)U/L、ADA为(11.82±2.64)U/L、IgM为(18.91±8.62)mg/L、IgG为(180.70±42.29)mg/L、IgA为(41.61±11.42)mg/L;病毒性脑膜炎组LDH为(22.42±9.57)U/L、ADA为(2.65±0.64)U/L、IgM为(5.83±1.34)mg/L、IgG为(20.91±10.34)mg/L、IgA为(7.20±2.31)mg/L。三组中枢神经系统感染性疾病中,结核性脑膜炎组与化脓性脑膜炎组脑脊液中IgM、IgG、IgA、LDH含量均较病毒性脑膜炎组显著增高(P<0.01),其中结核性脑膜炎组以IgG、IgA升高最明显,化脓性脑膜炎组以IgM升高最明显;结核性脑膜炎组脑脊液ADA活性与对照组和其它两组相比明显增高(P<0.01);病毒性脑膜炎组与对照组比较,各项指标差异无统计学意义(P>0.05)。结论中枢神经系统感染患者的血脑屏障受到不同程度损伤,脑脊液中免疫球蛋白、LDH检测有助临床对三种脑膜炎的诊断与鉴别诊断;ADA在早期诊断结核性脑膜炎时具有较高的临床价值。

Objective To study the immunoglobulins（Ig）, lactate dehydrogenase（LDH） and adenosine deaminase （ADA） activity in cerebrospinal fluid（CSF） for differential diagnosis of three type meningitis. Methods Immunoglobulins, lactate dehydrogenase and adenosine deaminase in cerebrospinal fluid were measured in 15 cases of tuberculous meningitis, 18 of purulent meningitis, 20 of viral meningitis and compared with 16 control cases. Results The concentrations of LDH, ADA, IgM, IgG, IgA in CSF of the patients with purulent meningitis were （ 85.62 ± 18, 13） U/L, （2.58± 0.52）U/L, （63.84± 13.43）mg/L, （92.57± 35.19）mg/L, （20.62± 8.74）rag/L, respectively; their levels in tuberculous meningitis group were （78.83 ± 22.39） U/L, （ 11.82 ± 2.64） U/L, （ 18.91 ± 8.62） mg/L, （180.70± 42.29）mg/L, （41.61 ± 11.42）mg/L, respectively; their levels in viral meningitis group were （22.42 ± 9.57）U/L, （2.65±0.64）U/L, （5.83±l.34）mg/L, （ 20.91± 10.34）rag/L, （7.20±2.31）mg/L,respectively. The concentrations of lgM, IgG, IgA, LDH in CSF of the patients with tuberculous meningitis or purulent meningitis were significantly higher than those in viral meningitis（P 〈 0.01 ）, the levels of lgG and IgA in the patients with tuberculous meningitis were significantly higher than those in other two groups, while the level of IgM in the patients with purulent meningitis was significantly higher than that in other two groups（P〈 0.01 ） ; the level of ADA in the patients with tuberculous meningitis was significantly higher than that in other two groups（P〈 0.01） ; There were no significant differences in these parameters between viral meningitis group and control group（P 〉 0.05） . Conclusions The concentrations of Ig, LDH in CSF are helpful to diagnosis and differentially diagnosis of three type meningitis. The level of ADA in CSF has important clinical value to diagnosis of tuberculous meningitis.