脑脊液单核细胞早期分泌性抗原靶-6联合脑脊液阿拉伯糖甘露糖脂抗体对结核性脑膜炎的诊断价值研究

Diagnostic Value of ESAT-6 of CSF Mononuclear Cells Combined with CSF LAM-IgG on Tuberculous Meningitis

目的探讨脑脊液单核细胞早期分泌性抗原靶-6(ESAT-6)联合脑脊液阿拉伯糖甘露糖脂(LAM)抗体对结核性脑膜炎的诊断价值。方法选择2010年1月—2014年8月在新乡医学院第一附属医院住院的结核性脑膜炎患者49例作为结核性脑膜炎组,化脓性脑膜炎患者28例作为化脓性脑膜炎组,病毒性脑膜炎患者24例作为病毒性脑膜炎组,同期体检健康者60例作为正常对照组。各组受检者均进行脑脊液细胞学检查和生化检查,脑脊液单核细胞ESAT-6及LAM抗体检测,并通过绘制ROC曲线评价脑脊液单核细胞ESAT-6、脑脊液LAM抗体及二者联合(并联试验)对结核性脑膜炎的诊断效能。结果 4组受检者脑脊液白细胞计数、中性粒细胞分数、淋巴细胞分数及单核细胞分数比较,差异均有统计学意义(P<0.05)。4组受检者脑脊液蛋白含量、糖含量、氯化物含量比较,差异均有统计学意义(P<0.05)。脑脊液单核细胞ESAT-6诊断结核性脑膜炎的曲线下面积(AUC)为0.876〔95%CI(0.764,0.910)〕,取最佳临界值时灵敏度为89.80%、特异度为96.43%;脑脊液LAM抗体诊断结核性脑膜炎的AUC为0.852〔95%CI(0.560,0.890)〕,取最佳临界值时灵敏度为55.10%、特异度为100.00%;两者联合诊断结核性脑膜炎的AUC为0.924〔95%CI(0.850,1.000)〕,取最佳临界值时灵敏度为92.00%、特异度为97.30%。结论脑脊液单核细胞ESAT-6联合脑脊液LAM抗体对结核性脑膜炎的诊断效能较高,有助于提高诊断结核性脑膜炎的灵敏度。

Objective To explore the diagnostic value of ESAT-6 of CSF mononuclear cells combined with CSF LAM-Ig G on tuberculous meningitis. Methods From January 2010 to August 2014 in the First Affiliated Hospital of Xinxiang Medical College,49 inpatients with tuberculous meningitis were selected as A group,28 inpatients with purulent meningitis were selected as B group,24 inpatients with viral meningitis were selected as C group,and 60 healthy cases admitted to the hospital for physical examination were selected as D group. All of the four groups underwent CSF cytology examination,CSF biochemical examination,ESAT-6 of CSF mononuclear cells detection and CSF LAM-Ig G detection,ROC curve was drawn to evaluate the diagnostic value of ESAT-6 of CSF mononuclear cells,CSF LAM-Ig G and combination of both on diagnosis of tubercular meningitis. Results There were statistically significant differences of WBC,neutrophil percentage,lymphocyte percentage and monocyte percentage of CSF among the four groups（ P〈0. 05）. There were statistically significant differences of protein content,sugar content and chloride content of CSF among the four groups（ P〈0. 05）. The AUC of ESAT-6 of CSF mononuclear cells in diagnosing tuberculous meningitis was 0. 876 〔95% CI（ 0. 764,0. 910） 〕,the sensitivity was 89. 80%,the specificity was 96. 43%; the AUC of CSF LAM-Ig G in diagnosing tuberculous meningitis was 0. 852 〔95% CI（ 0. 560,0. 890） 〕,the sensitivity was 55. 10%,the specificity was 100. 00%; the AUC of combination of both in diagnosing tuberculous meningitis was 0. 924 〔95% CI（ 0. 850,1. 000） 〕,the sensitivity was 92. 00%,the specificity was 97. 30%. Conclusion Combination of ESAT-6 of CSF mononuclear cells and CSF LAM-Ig G has certainly high diagnostic value on tuberculous meningitis,which is helpful to improve the sensitivity.