脑脊液腺苷脱氨酶对结核性脑膜炎患者病情程度和疾病预后的预测价值

Predictive value of cerebrospinal fluid adenosine deaminase for degree of illness and disease prognosis of patients with tuberculous meningitis

目的探讨脑脊液腺苷脱氨酶(ADA)对结核性脑膜炎患者病情程度和疾病预后的预测作用。方法选取135例脑膜炎患者,其中结核性脑膜炎(结核组)50例,病毒性脑膜炎(病毒组)45例,细菌性脑膜炎(细菌组)40例,同期选取50例健康体检者(对照组)。全部研究对象采用酶显色检测法检测ADA水平,并进行比较。结核组患者根据全身性炎症反应程度进行分组,分为未合并败血症组、合并轻度败血症组和合并重症败血症组,比较三组ADA水平,分析脑脊液ADA在结核性脑膜炎患者病情、预后评估中的价值。结果结核组脑脊液ADA水平明显高于病毒组、细菌组和对照组,组间比较差异有统计学意义(P<0.05),合并重症败血症组ADA水平明显高于未合并败血症组和合并轻度败血症组,组间比较差异有统计学意义(P<0.05),治疗后3、6、9周ADA水平显著低于入院时,差异有统计学意义(P<0.05),且预后不良组ADA水平明显高于预后良好组(P<0.05)。结论脑脊液ADA在结核性脑膜炎的诊断中具有重要的意义,在病情和疾病预后的预测方面具有可靠的价值。

Objective To investigate the predictive effect of cerebrospinal fluid （CSF） adenosine deaminase （ADA） for tubercular meningitis patients severity and prognosis of the disease. Methods 135 cases of meningitis were selected, and included 50 cases of tubercular meningitis （the tuberculosis group）, 45 cases of viral meningitis （the virus group）, 40 cases of bacterial meningitis （the bacterial group）. 50 healthy subjects were selected as the control group in the same period. The ADA levels of all research objects were detected by enzyme color detection and were compared. TB patients grouped according to systemic inflammatory reaction degree, who were divided into the unincorporated sepsis groups, the mild sepsis group and the combining severe sepsis group, the ADA levels of the three groups were com-pared, the predictive effect of CSF ADA for tubercular meningitis patients severity and prognosis of the disease were analyzed. Results CSF ADA of the tuberculosis group was significantly higher than the viruses group, the bacteria group and the control group （P〈0.05）;ADA levels of patients in severe sepsis group was significantly higher than the none sepsis group and the mild sepsis group （P〈0.05）; after treatment for 3, 6, 9 weeks, ADA were significantly lower than patients admission （P 〈 0.05）; and ADA level of the poor prognosis group was obviously higher than the good prognosis group （P〈0.05）. Conclusion CSF ADA has important significance in the diagnosis of tubercular meningitis, and predictive value of severity and disease prognosis is reliable.