隐球菌性脑膜炎脑脊液四种检测方法的比较

Comparison of Four Methods for Detection of Cryptococcal Meningitis Cerebrospinal Fluid

目的:比较隐球菌性脑膜炎患者脑脊液中检测隐球菌四种方法的优缺点。方法:分别采用墨汁染色法、真菌培养法、隐球菌抗原乳胶凝集法、聚合酶链反应法(PCR)检测脑脊液中的新型隐球菌属。结果:墨汁染色法、真菌培养法、乳胶凝集法、PCR法四种方法的阳性率和符合率分别是75.00%与79.59%、84.62%与89.80%、91.35%与96.94%、100.00%与94.23%;墨汁染色法阳性率和符合率低,不适合早期诊断;真菌培养法特异性好,但敏感性低,报告时间长;乳胶凝集法的特异性和敏感性高,但容易出现假阳性;PCR法特异性、敏感性高,但也有5.77%的假阳性。真菌培养法、乳胶凝集法、PCR法的符合率明显高于墨汁染色法。结论:四种方法各有优缺点,应根据临床病程灵活选择。

Objective:To compare the detection of Cryptococcus in cerebrospinal fluid in the patients with Cryptococcus meningitis and the advantages and disadvantages of the four methods.Methods:Use the ink staining method,fungi culture method,Cryptococcus antigen latex agglutination method and the method of polymerase chain reaction(PCR)to detect Cryptococcus neoformans in CSF.Results:Ink staining method and fungi culture method,latex agglutination method,PCR method,four methods of positive rate and the coincidence rate is 75.00% and 79.59%,84.62% and89.80%,91.35% and 96.94%,100.00% and 94.23%respectively.Ink staining positive rate and the coincidence rate is low,not suitable for early diagnosis;fungi culture method specificity,but low sensitivity,and use a long time to report.Antigen latex agglutination method,high specificity and sensitivity,but easy to produce false positive results;PCR method specificity,high sensitivity,5.77%false positive.The coincidence rate of culture method and latex agglutination method and PCR method was significantly higher than that of the ink staining method.Conclusion:The four methods have their advantages and disadvantages,and we should choose them according to the clinical course need.