脑脊液腺苷脱氨酶在AIDS合并结核性脑膜炎诊断及疗效评估中的价值

Value of adenosine deaminase in cerebrospinal fluid for diagnosis and efficacy evaluation of AIDS complicated with tuberculous meningitis

目的探讨脑脊液腺苷脱氨酶(ADA)测定对AIDS合并结核性脑膜炎的诊断及疗效评估价值。方法回顾性分析该院收治的AIDS合并结核性脑膜炎30例(结核性脑膜炎组)的临床资料,其中CD4+T淋巴细胞>200个/μl者14例;CD4+T淋巴细胞≤200个/μl者16例,于入院1周内治疗前、治疗后2周、4周、6周检测其脑脊液的ADA值。选择同期AIDS合并新型隐球菌性脑膜炎26例(隐球菌性脑膜炎组),AIDS合并弓形虫脑炎12例(弓形虫脑炎组),检测其入院治疗前脑脊液ADA。结果结核性脑膜炎组患者治疗前脑脊液ADA水平均高于其他两组(P<0.05);不同CD4+T淋巴细胞水平的AIDS合并结核性脑膜炎患者脑脊液ADA水平比较,差异无统计学意义(P>0.05);AIDS合并结核性脑膜炎患者治疗后2周、治疗后4周及治疗后6周的ADA水平均低于入院时ADA水平(P<0.05),治疗后4周的ADA水平低于治疗后2周(P<0.05),治疗后6周的ADA水平亦低于治疗后4周(P<0.05)。结论脑脊液ADA在AIDS合并结核性脑膜炎的早期诊断及疗效评估中具有重要意义。

Objective To investigate the value of detecting denosine deaminase（ ADA） in cerebrospinal fluid for the diagnosis and efficacy evaluation of AIDS complicated with tuberculous meningitis. Methods The clinical data of 30 patients with AIDS complicated with tuberculosis meningitis（ tuberculous meningitis group） were retrospectively analyzed. The 30 cases included 14 cases of CD4^＋T lymphocytes 200 / μl and 16 cases of CD4^＋T lymphocytes ≤200 / μl. And the levels of ADA in cerebrospinal fluid were detected in 30 patients before treatment and within one week after admission,2,4 and 6 weeks after treatment. Twenty-six cases of AIDS complicated with novel cryptococcal meningitis（ cryptococcal meningitis group） and 12 of AIDS complicated with toxoplasmic encephalitis（ toxoplasmic encephalitis group） during the same period were enrolled in the study,and the levels of ADA in cerebrospinal fluid were detected before hospitalized treatment. Results Before treatment,the level of ADA in cerebrospinal fluid in the tuberculosis meningitis group was higher than that in another two groups（ P〈0. 05）. For patients with AIDS complicated with tuberculosis meningitis,there was no significant difference in the level of ADA in cerebrospinal fluid between two groups of different CD4^＋T lymphocyte levels（ P〉0. 05）,the ADA levels 2,4 and 6 weeks after treatment were lower than the level at admission（ P〈0. 05）,and the level 4 weeks after treatment was lower than that 2 weeks after treatment（ P〈0. 05）,the level 6 weeks after treatment was also lower than that 4 weeks after treatment（ P〈0. 05）. Conclusion ADA in cerebrospinal fluid has important significance in the early diagnosis and efficacy evaluation of AIDS complicated with tuberculous meningitis.