脑脊液单核细胞内结核分枝杆菌早期分泌性抗原检测对结核性脑膜炎早期诊断评价

Evaluation of early secretory antigen test of Mycobacterium tuberculosisin cerebrospinal fluid mononuclear cells for the early diagnosis of tuberculous meningitis

目的探讨分析脑脊液单核细胞内结核分枝杆菌早期分泌性抗原(ESAT-6)检测对结核性脑膜炎早期诊断评价,为尽早诊断治疗、减少并发症提供参考依据。方法选取2013年6月-2015年6月收治的140例中枢神经系统感染患者,其中结核性脑膜炎(TBM)患者70例为TBM组,非结核性脑膜炎患者70例为非TBM组;两组患者均常规腰椎穿刺,取脑脊液(CSF)样本及外周血样本(PB),通过免疫组化法对CSF样本以及PB样本进行检测,分析样本中ESAT-6、结核菌素纯化蛋白衍生物(PPD)以及腺苷脱氨酶(ADA)的表达。结果 TBM组、非TBM组CSF白细胞计数>5×106/L患者阳性率分别为51.43%、54.29%;蛋白含量>0.45g/L患者阳性率分别为65.71%、61.43%;脊液糖含量<2.5mg/L患者阳性率分别为60.00%、54.29%;氯化物量<120mol/L患者阳性率分别为52.86%、45.71%,两组患者以上指标比较,差异均无统计学意义;TBM组、非TBM组患者脑脊液ADA表达阳性率分别为38.57%、18.57%;PPD表达阳性率分别为32.86%、14.29%;ESAT-6表达阳性率分别为87.14%、1.43%,与非TBM组患者相比,TBM组ADA、PPD以及ESAT-6表达阳性率均显著提高(P<0.05)。对于TBM组患者,脑脊液ESAT-6表达阳性率显著高于ADA、PPD表达阳性率(P<0.05)。TBM组脑脊液及外周血中ESAT-6表达阳性率分别为87.14%、42.86%,与外周血相比,脑脊液ESAT-6表达阳性率显著升高(P<0.01)。结论 ESAT-6在TBM患者脑脊液中高度特异性表达,在结核性脑膜炎早期诊断中具有较高的价值,值得临床推广。

OBJECTIVE To investigate and analyze the evaluation of early secretory antigen（ESAT-6）test of Mycobacterium tuberculosis in cerebrospinal fluid mononuclear cells for the early diagnosis of tuberculous meningitis,so as to provide reference for the early diagnosis and treatment of reducing complications.METHODS A total of140 cases with central nervous system infections admitted in our hospital from Jun.2013 to Jun.2015 were chosen.They were divided into two groups,70 cases were with tuberculous meningitis（TBM）,and 70 patients were with non-tuberculous meningitis.The two groups were taken with routine lumbar puncture.The fluid（CSF）samples were taken.The outer periphery blood（PB）was taken for blood samples.The CSF samples and PB samples were taken immunohistochemistry for test.The ESAT-6,tuberculin purified protein derivative（PPD）and the expression of adenosine deaminase（ADA）of samples were analyzed.RESULTS The positive rates of white blood cell number〉5×10^6/L in the TBM group and the non-TBM group were 51.43%and 54.29%.The positive rates of protein content 〉0.45g/L were 65.71% and 61.43%.The positive rates of spinal fluid sugar content〈2.5mg/L were 60.00% and 54.29%.The positive rates of the amount of chloride 〈120mol/L were 52.86%and 45.71%.The differences of the two groups were compared,and the differences had no significance.The positive expressions of cerebrospinal fluid ADA in the TBM group and the non-TBM group were 38.57%and 18.57%.The PPD positive expression rates were 32.86% and 14.29%.The ESAT-6expression positive rates were 87.14% and 1.43%.Compared with the non-TBM group,the ADA,PPD and ESAT-6expression in the TBM group was significantly increased（P〈0.05）.The ESAT-6expression positive rate of cerebrospinal fluid in the TBM group was significantly higher than the ADA,PPD positive expression rate（P〈0.05）.The ESAT-expression positive rates in the erebrospinal fluid and peripheral blood of TBM were 87.14% and 42.86%,and compared to peripheral blood the cerebrospinal fluid ESAT-6expression positive rate was significantly increased,（P 0.01）.CONCLUSION The ESAT-6high specific expression of cerebrospinal fluid in TBM has higher evaluation in the early diagnosis of tuberculous meningitis,and it is worthy of promotion.