脑脊液免疫球蛋白、乳酸脱氢酶及腺苷脱氨酶检测在成人颅内感染鉴别诊断中的临床意义

Clinical significance of immunoglobulins,lactatedehydrogenase,and adenosine deaminase detection in differential diagnosis of intracranial infections in adults

目的研究成人颅内感染脑脊液中免疫球蛋白(Ig)、乳酸脱氢酶(LDH)及腺苷脱氨酶(ADA)的改变及临床价值。方法检测结核性脑膜炎17例、化脓性脑膜炎19例、病毒性脑膜炎21例患者脑脊液中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(85.60±18.11)U/L、ADA为(2.59±0.52)U/L、IgM为(63.85±13.44)mg/L、IgG为(92.55±35.18)mg/L、IgA为(20.60±8.75)mg/L;结核性脑膜炎组LDH为(78.80±22.38)U/L、ADA为(11.83±2.65)U/L、IgM为(18.90±8.62)mg/L、IgG为(180.69±42.28)mg/L、IgA为(41.63±11.42)mg/L;病毒性脑膜炎组LDH为(22.43±9.56)U/L、ADA为(2.66±0.64)U/L、IgM为(5.83±1.34)mg/L、IgG为(20.90±10.35)mg/L、IgA为(7.20±2.30)mg/L;3组成人颅内感染性疾病中,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活性与对照组和其他两组相比明显增高(P<0.01),病毒性脑膜炎组与对照组各项指标比较,差异无统计学意义。结论成人颅内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3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 investigate the changes of immunoglobulin（Ig）,lactate dehydrogenase（LDH）,and adenosine deaminase（ADA） in cerebrospinal fluid（CSF）of the adults with intracranial infections and explore the clinical significance.METHODS Totally 17 patients with tuberculous meningitis,19 patients with purulent meningitis,and 21 patients with viral meningitis were recruited in this study.The levels of LDH,ADA,and Ig in CSF from each patient were measured and compared with the control group.RESULTS The concentrations of LDH,ADA,IgM,IgG,and IgA in CSF of the patients with purulent meningitis were（85.60±18.11）U/L,（2.59±0.52）U/L,（63.85±13.44）mg/L,（92.55±35.18）mg/L,and（20.60±8.75）mg/L,respectively;the levels of LDA,ADA,IgM,IgG,and IgA in CSF of the patients with tuberculous meningitis were（78.80±22.38）U/L,（11.83±2.65）U/L,（18.90±8.62）mg/L,（180.69±42.28）mg/L,and（41.63±11.42）mg/L,respectively;the levels of LDA,ADA,IgM,IgG,and IgA in CSF of the patients with viral meningitis were（22.43±9.56）U/L,（2.66±0.64）U/L,（5.83±1.34）mg/L,（20.90±10.35）mg/L,and（7.20±2.30）mg/L,respectively;of the three groups of adults with intracranial infectious diseases,the levels of IgM,IgG,IgA,and LDH in CSF of the patients with tuberculous meningitis or purulent meningitis were significantly higher than those in the patients with viral meningitis（P〈0.01）,the levels of IgG and IgA in CSF of the patients with tuberculous meningitis increased most significantly,the level of IgM in CSF of the patients with purulent meningitis increased most significantly,the activity of ADA of the tuberculous meningitis group was significantly higher than control group and other two groups（P〈0.01）;no statistical significance was found when between the indexes of viral meningitis group and control group.CONCLUSION The blood brain barriers of adult patients have been injured in varying degrees,the detection of Ig,LDH in CSF is helpful to clinical diagnosis and differential diagnosis of three type meningitis;the detection of ADA in CSF has important clinical significance in diagnosis of tuberculous meningitis in early stage.