脑脊液腺苷脱氨酶、白介素23联合检测在结核性脑膜炎相关疾病诊断中的临床价值

Clinical value of cerebrospinal fluid ADA,IL-23 joint detection in the diagnosis of tuberculous meningitis ;related diseases

目的：探讨脑脊液腺苷脱氨酶（ADA）、白介素23（IL-23）联合检测在结核性脑膜炎相关疾病诊断中的临床应用价值。方法选择结核性脑膜炎相关疾病患者253例为研究对象，按诊断分为结核性脑膜炎组（脑膜炎组）138例、结核性脑膜炎合并脑积水组（脑积水组）35例和对照组80例。所有患者入院后均行腰椎穿刺术，将部分脑脊液标本即刻送检，行脑脊液ADA、IL-23联合检测；脑膜炎组和脑积水组患者均行抗结核药物（INH＋RFP＋PZA＋sm方案）的联合化学治疗；在治疗3个月后脑膜炎组和脑积水组患者再次腰椎穿刺术行脑脊液ADA、IL-23联合检测。比较各组脑脊液ADA、IL-23含量的变化。结果治疗前，脑膜炎组脑脊液ADA、IL-23分别为（12．64±5．54）u／L、（48．38±10．78）pg／mL，脑积水组脑脊液 ADA、IL-23分别为（15.81±6．92）u／L、（77．21±13．42）pg／mL，对照组脑脊液 ADA、IL-23分别为（3．21±2．20）u／L、（9．05±3.89）pg／mL，脑膜炎组和脑积水组治疗前脑脊液ADA、IL-23均明显高于对照组（F＝117．24、724．97，均P＜0．001）；Spearma分析显示，各组脑脊液ADA与IL-23无相关性。治疗后，脑膜炎组脑脊液ADA、IL-23分别为（3．79±3．13）u／L、（13．46±6．62）pg／mL，脑积水组脑脊液ADA、IL-23分别为（6．42±4．35）u／L、（25．42±8.54）pg／mL，脑膜炎组治疗前后脑脊液ADA、IL-23差异均有统计学意义（t＝16．34、32．43，均P＜0．001）；脑积水组治疗前后脑脊液 ADA、IL-23差异也有统计学意义（t＝6．80、19．26，均 P＜0．001）。结论脑脊液ADA、IL-23联合检测在结核性脑膜炎相关疾病的早期诊断及疗效观察中具有较高临床价值。

Objective To evaluate the clinical value of cerebrospinal fluid ADA,IL-23 joint detection in the diagnosis of tuberculous meningitis related diseases.Methods 253 cases with tuberculous meningitis related diseases were selected as the research subjects.According to the diagnosis,they were divided into tuberculous meningitis group （meningitis group,138 cases ）,tuberculous meningitis complicated with hydrocephalus group （hydrocephalus group,35 cases）and control group（80 cases）.All patients after admission received lumbar puncture, the part of cerebrospinal fluid specimens were inspected,the cerebrospinal fluid ADA,IL -23 joint test was conducted.Meningitis group and hydrocephalus group were given anti -TB drugs （INH,RFP and PZA ＋sm ） combined with chemotherapy.3 months after treatment,the meningitis group and hydrocephalus group received lumbar puncture cerebrospinal fluid ADA,IL -23 joint test again.The levels of ADA,IL -23 in cerebrospinal fluid were＆amp;nbsp;compared.Results Before treatment,cerebrospinal fluid ADA,IL-23 levels in the meningitis group were （12.64 ± 5.54）u/L and （48.38 ±10.78）pg/mL,those in the hydrocephalus group were （15.81 ±6.92）u/L and （77.21 ± 13.42 mm）pg/mL,which in the control group were （3.21 ±2.20）u/L and （9.05 ±3.89）pg/mL,ADA,IL-23 levels in meningitis group and hydrocephalus group before treatment were significantly higher than the control group （F=117.24,724.97,P〈0.001）.Spearma analysis showed that each group of cerebrospinal fluid ADA and IL-23 had no correlation.After treatment,the cerebrospinal fluid ADA,IL-23 levels in the meningitis group were （3.79 ± 3.13）u/L and （13.46 ±6.62）pg/mL,which in the hydrocephalus group were （6.42 ±4.35）u/L and （25.42 ± 8.54）pg/mL,the meningitis group before and after treatment had statistically significant differences in cerebrospinal fluid ADA,IL-23 （t=16.34,32.43,all P〈0.001）;hydrocephalus group before and after treatment had statistically significant differences in cerebrospinal fluid ADA,IL-23 （t=6.80,19.26,all P〈0.001 ）.Conclusion Cerebro-spinal fluid ADA,IL-23 joint detection in the early diagnosis of tuberculous meningitis related diseases and clinical observation has high clinical value.