结核性脑膜炎患儿脑脊髓液中腺苷脱氨酶活性测定的临床意义

Clinical Significance of Cerebrospinal Fluid Adenosine Deaminase of Children with Tuberculous Meningitis

目的:评价结核性脑膜炎患儿脑脊髓液中腺苷脱氨酶(CSF-ADA)活性对临床诊断意义及疗效判断价值。方法:选择122例住院患儿为研究对象,56例结核性脑膜炎患者为A组;66例非结核性脑膜炎患者为对照组,其中细菌性脑膜炎32例为B组,病毒性脑膜炎34例为C组,采用酶耦联Trinder法测定患儿治疗前CSF-ADA活性,56例结核性脑膜炎患儿于抗结核治疗后2周和6周时分别检测CSF-ADA。结果:A组CSF-ADA活性为(11.8±4.4)U/L,B组为(6.1±2.8)U/L,C组为(4.9±3.1)U/L,与A组比较差异有统计学意义(F=45.150,P=0.000)。取CSF-ADA≥8U/L作为临界值时鉴别结核性脑膜炎与非结核性脑膜炎价值最高,灵敏度为87.72%,特异度为90.77%。随着患儿病情好转,CSF-ADA活性逐渐降低。结论:CSF-ADA活性≥8U/L可作为诊断结核性脑膜炎的一项辅助诊断指标,抗结核治疗后CSF-ADA活性可作为疗效判断的参考指标。

Objective： Evaluation of tuberculous meningitis with cerebrospinal fluid of adenosine deaminase（CSF-ADA） activity to clinical diagnosis significance and effect of value judgment. Method： To choose 122 cases hospitalized children as the research object, 56 cases of tuberculous meningitis was the case group （group A）. 66 cases of meningitis of n/med tuberculosis sex as control group, including bacterial meningitis 32 cases （group B）, and viral meningitis 34 cases （C group）, using enzyme coupling Trinder spectrometry to analyze CSF-ADA activity before treatment. 56 cases of tuberculous meningitis in antitubercular treatment children after 2 weeks and six weeks respectively detection CSF-ADA. Result： The CSF-ADA activity of group A was（11.8±4.4） U/L, compared with group B（6.1±2.8） U/L, group C（4.9±3.1） U/L, there was a significant difference meaning （F=45.150, P=0.000）. Taking the CSF-ADA≥8 U/L as critical value in identification of tuberculous meningitis had the highest value, and sensitivity was 87.72% and specificity was 90.77%. As patients improved, CSF-ADA activity gradually reduced. Conclusion： CSF-ADA activity was 8 U/L can be used as a auxiliary diagnosis index of tuberculous meningitis, CSF-ADA activity can be used as curative effect judgment reference index.