Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis:A prospective cohort study

Objective:To identify the clinical,laboratory,and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis.Methods:In this prospective,observational study,patients with tuberculous meningitis were systematically evaluated.Various clinical,laboratory[including cerebrospinal fluid(CSF)microscopy,culture,and GeneXpert],and neuroimaging factors were examined.All participants were administered anti-tuberculous treatment and corticosteroids.A six-month follow-up was done to evaluate the outcome.Results:Of the 116 patients studied,54(46.6%)tested positive for GeneXpert,while 62(53.4%)were negative.Third cranial nerve involvement(OR 3.71,95%CI 1.052-13.09,P=0.04)and the presence of basal exudates on neuroimaging(OR 5.22,95%CI 2.03-13.42,P=0.001)emerged as independent predictive factors for a positive GeneXpert result.A positive CSF GeneXpert result(P=0.002)and drug resistance(P=0.004)were significantly linked to adverse outcomes.Additionally,a high score on the Medical Research Council stageⅢ(OR 5.64,95%CI 1.18-26.87,P=0.03)and elevated CSF cell counts(OR 1.002,95%CI 1.00-1.001,P=0.03)were identified as independent predictors of poor prognosis.Conclusions:Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result.MRC stageⅢdisability and elevated CSF cell counts predicted poor outcomes.

Diagnostic Value of Cerebrospinal Fluid T-SPOT.TB for Tuberculousis Meningitis in China

The aim of this study was to evaluate the diagnostic value of the cerebrospinal fluid（CSF） T‐SPOT.TB test for the diagnosis of TB meningitis（TBM）. A retrospective analysis of 96 patients with manifested meningitis was conducted; T‐SPOT.TB test was performed for diagnosing TBM to determine the diagnostic sensitivity, specificity, positive predictive value（PPV）, and negative predictive value（NPV）. A receiver operating characteristic（ROC） curve was also drawn to assess the diagnostic accuracy. The sensitivity, specificity, PPV, and NPV of CSF T‐SPOT.TB test were 97.8%, 78.0%, 80.3%, and 97.5%, respectively, for 52 patients（54.2%） of the 96 enrolled patients. The area under the curve（AUC） was 0.910, and the sensitivities of CSF T‐SPOT.TB for patients with stages I, II, and III of TBM were 96.7%, 97.2%, and 98.9%, respectively. CSF T‐SPOT.TB test is a rapid and accurate diagnostic method with higher sensitivity and specificity for diagnosing TBM.

Levels of soluble delta-like ligand 1 in the serum and cerebrospinal fluid of tuberculous meningitis patients

In this study, the levels of soluble delta-like ligand 1 in cerebmspinal fluid and serum of 50 patients with tuberculous meningitis, 30 patients with viral meningitis, 20 patients with purulent meningitis and 40 subjects without central nervous system disease were determined using an enzyme-linked immunosorbent assay. The mean levels of soluble delta-like ligand 1 in both cerebrospinal fluid and serum from patients with tuberculous meningitis were significantly higher compared with those from patients with viral meningitis or purulent meningitis or from subjects without central nervous system disease. Meanwhile, the level of soluble delta-like ligand 1 gradually decreased as tuberculous meningitis patients recovered. If patients deteriorated after treatment, the level of soluble delta-like ligand 1 in cerebrospinal fluid gradually increased. There was no correlation between the level of soluble delta-like ligand 1 and the protein level/cell number in cerebrospinal fluid. Our findings indicate that the levels of soluble delta-like ligand 1 in cerebrospinal fluid and serum are reliable markers for the diagnosis of tuberculous meningitis and for monitoring treatment progress. At the same time, this index is not influenced by protein levels or cell numbers in cerebrospinal fluid.

Meningeal cryptococcosis in a pancreas transplant recipient requiring grafectomy: A case report

BACKGROUND Through continuous improvement in transplantation medicine,a wider range of solid organ transplant(SOT)recipients is considered suitable for complex procedures.Despite advances in modern transplantation practice,transpiring invasive fungal infections pose a substantial threat for SOT recipients.To our knowledge,cryptococcal infection confined amidst sole pancreas SOT recipients has not been described to date.Enforcement of a multidisciplinary transplant team approach in the management of pancreas SOT recipients presenting with complex cryptococcal complications is fundamental in improving patient outcomes.CASE SUMMARY We present the case of a female pancreas transplant recipient,with confirmed meningeal cryptococcosis,referred to our institution for further evaluation and treatment from the Regional Center for Infectious Diseases.On admission,the patient was weaned from the protocolized immunosuppression therapy for two consecutive weeks,in addition to tapering systemic corticosteroid remedial treatment.Our novel multidisciplinary transplant team approach embodied exhaustive discussions of possible complex and diverse multiple organ system physiologic and pathologic challenges associated with distinct management strategies in pancreas transplant recipients.Owing to the potentially devastating impact of invasive cryptococcosis in terms of morbidity and mortality,a definitive surgical intervention of pancreas transplant grafectomy was reinforced,as a pathway towards secure access to early meaningful expertise care.The patient was discharged to the Regional Center for Infectious Diseases 2 mo after the admittance further advancing to a clinical improvement.CONCLUSION The precision transplantation approach by tailoring complex medical interventions to individual needs proved indispensable in improving our patient’s outcomes.

Case Report: Bilateral Intra-Parenchymal Hematomas Caused by Ventricular Flood Complicating Neonatal Salmonella typhi Meningitis

Salmonella meningitis is an uncommon condition in neonates, and when it does occur, it is often linked to serious complications, such as subdural collections and abscesses. We present a case involving a 23-day-old neonate diagnosed with Salmonella meningitis, who developed complications including bilateral intra-parenchymal hematomas with ventricular involvement. The infant showed significant improvement following an extended course of systemic antibiotics and supportive care.

Two Cases of Tuberculous Meningitis after Cesarean Section

This article revealed two valuable case reports about two young females suffered tuberculous meningitis after cesarean section.After antituberculous therapy,the condition of one patient improved and the other one became deteriorated.

Changes of insulin-like growth factor-Ⅱ and insulin-like growth factor binding protein-3 in cerebrospinal fluid of children with tuberculous meningitis

BACKGROUND： Recent studies have found that insulin-like growth factors （IGFs） and insulin-like growth factor binding protein-3 （IGFBP-3） have stronger neurotrophic and neuroprotective effects. But whether their levels in cerebrospinal fluid could be used as an auxiliary indicator in differentially diagnosing tuberculous meningitis and viral encephalitis is not yet clear. OBJECTIVE： To explore the changes of insulin-like growth factor-Ⅱ （IGF-Ⅱ ） and IGFBP-3 in cerebrospinal fluid （CSF） of children with tuberculous meningitis and the significance of the changes. DESIGN： A non-randomized concurrent controlled study. SETTING： Department of Pediatric Internal Medicine, the First Affiliated Hospital of Xinxiang Medical College. PARTICIPANTS： Thirty children with tuberculous meningitis （14 males and 16 females） were selected from the Department of Pediatric Internal Medicine, the First Affiliated Hospital of Xinxiang Medical College from January 2005 to December 2006. Tuberculous meningitis was diagnosed according to their clinical manifestations, the history of close contact with tuberculosis, typical cerebrospinal fluid changes of tuberculous meningitis, positive tuberculosis antibody and effective antituberculosis treatment. There were 30 children （13 males and 17 females） with viral encephalitis, and viral encephalitis was diagnosed according to epidemiological history, clinical manifestations, conventional and biochemical changes of cerebrospinal fluid, and negative bacteriology judgment. Meanwhile, 30 children （13 males and 17 females） without infectious and central nervous system disease were selected as the control group. Informed consent was obtained from the parents of all the enrolled children. METHODS： ①The lumbar puncture operation was implemented immediately to obtain cerebrospinal fluid （3 mL）. The contents of IGF-Ⅱ and IGFBP-3 were detected with immunoradiometric assay. The concentrations of glucose and protein in cerebrospinal fluid were determined with a dry-chemical method. The number of white blood cells was counted by Fushi Method. ②The Pearson correlation analysis was used to analyze the correlation of the contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid with the leucocyte counting and the concentrations of glucose and protein in cerebrospinal fluid. MAIN OUTCOME MEASURES： The contents of IGF- Ⅱ and IGFBP-3 in cerebrospinal fluid, and their correlation with the leucocyte counting and the concentrations of glucose and protein in cerebrospinal fluid. RESULTS： ①Contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid： The contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid in the tuberculous meningitis group were significantly higher than those in the encephalitis virus group and control group （P 〈 0.05）. There was no significant difference in the contents of IGF- Ⅱ and IGFBP-3 in cerebrospinal fluid between the viral encephalitis group and control group （P 〉 0.05）. ②Correlation： The IGF- Ⅱ and IGFBP-3 contents in cerebrospinal fluid were positively correlated with the protein concentration in cerebrospinal fluid （r =0.821, 0.855, P 〈 0.01）, but negatively with the glucose （r =0.742, - 0.605, P 〈 0.01）. CONCLUSION- ①IGFs and IGVBPs are involved in the pathophysiological process of tuberculous meningitis, as well as the glucose and protein metabolism in cerebrospinal fluid. ②The IGF-Ⅱ and IGFBP-3 contents in cerebrospinal fluid can be used as the auxiliary indicators to differentially diagnose tuberculous meningitis and viral enceohalitis.

Tuberculous meningitis and miliary tuberculosis in Iran:A review

In recent years,the number of cases of extrapulmonary tuberculosis in Iran has increased.The goal of this study was to determine the epidemiological status,clinical symptoms,diagnostic methods,and treatment strategies of extrapulmonary tuberculosis in Iran,with a focus on tuberculosis meningitis and miliary tuberculosis.Between January 1,2000 and June 1,2021,1651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran.The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan,South Khorasan,and Mazandaran compared with other provinces.The most prevalent symptoms of tuberculous meningitis were fever,anorexia,headache,neck stiffness,loss of consciousness,and vomiting.The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture.The most prevalent clinical symptoms of miliary tuberculosis were fever,lethargy,weariness,and anorexia.In 70%of chest radiographs,a miliary pattern was visible.Bone marrow biopsy was used to diagnose miliary tuberculosis in 80%of patients,while bronchoalveolar lavage was used in 20%of cases.The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations.Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease,the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

Tuberculous Meningitis and COVID-19 Co-Infection: About a Case

We report the case of an adult patient diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis. The most destructive type of extrapulmonary tuberculosis is tuberculous meningitis, in which the consequences are severe, resulting in death or disability in almost half of all sufferers despite anti-tuberculosis chemotherapy. The aim of this study was to assess the clinical and paraclinical features and laboratory findings and outcome of a patient with tuberculous meningitis and COVID-19 coinfection. Infection of COVID-19 and lymphopenia promotes the development of the severe form of tuberculosis. On the other hand, TBM increased the risk of infection with coronavirus due to the weakened immune system in addition to other immunosuppressive factors (older age and comorbidities such as low socioeconomic status and malnutrition). The patient had a good recovery even if he required intensive neurorehabilitation for a month due to poor feeding and weakness. Treatment, both anti-mycobacterial and anti-inflammatory, early started, guaranteed good recovery.

Tuberculous Meningitis: Diagnostic and Radiological Features, Pathogenesis and Biomarkers

Central nervous system tuberculosis is the most severe form of extrapulmonary tuberculosis disease. We aim to review the diagnostic and radiological features, pathogenesis, and biomarkers of tuberculous meningitis. We also aim to look at the latest development of research of the disease. The diagnosis of tuberculous (TB) meningitis is difficult because the disease presents with unspecific clinical features. However, the disease has excellent clinical response to antituberculous therapy. Good prognosis depends on prompt diagnosis with treatment and radiological findings are very important. There is an increase in the levels of serum and cerebrospinal fluid (CSF) TNF-in TB meningitis patients. IL-6 level is also increased in patients with tuberculoma and exudates. There is an increase in the levels of serum and CSF TNF-α and IFN-γ in TB meningitis patients. There is also a rise in the levels of IL-8, IFN-alpha, IFN-gamma, IL-10, CSF matrix metalloproteinases, CSF tissue inhibitors of matrix Metalloproteinases, VEGF level, caspase-1 and IL-1β. Signal-regulatory protein alpha is overexpressed at mRNA level. High dose intravenous rifampicin (800 mg daily) is associated with reduced mortality in patients with advanced disease.

Bilateral optic nerve infiltration in tuberculous meningitis: A diagnostic dilemma

Rationale:Tuberculous meningitis(TBM)is severe extrapulmonary tuberculosis that can cause poor outcomes without timely treatment.We report a case of presumed TBM that presented solely ocular complaints without other neurological features.Patient's concerns:A 71-year-old man presented with a sudden central visual defect in both eyes for 10 days.Fundoscopy showed bilateral hyperaemic swelling disc with infiltrates.Diagnosis:A diagnosis of presumptive TBM was made with Mantoux test reading 15 mm,elevated erythrocyte sedimentation rate,subdural effusion on CT scan,and high opening pressure.Intervention:Anti-tuberculous treatment.Outcomes:Bilateral vision improved and optic discs swelling resolved.Lessons:Early recognition of TBM with optic nerve infiltration is crucial for prompt treatment that may lead to a good prognosis.Neuroimaging will facilitate the diagnosis when other investigations show a borderline result.

结核性脑膜炎(Tuberculous meningitis)的治疗

结核性脑膜炎(结脑)是一严重的疾病。1946年抗结核药物出现前,结脑患者几乎全部死亡。近代抗痨治疗虽然有进步,但疗效仍然不满意,多留后遗症。治疗原则1.尽量早期治疗。只要疑及结脑,即刻开始抗结核治疗。2.选用一联合易透过血脑屏障的抗结核方案。3.余同肺结核的抗痨治疗原则。

Significance of cerebrospinal fluid and plasma biochemical indicator ratio in identifying the tuberculous meningitis and purulent meningitis

Objective:To explore the significance of cerebrospinal fluid and plasma biochemical indicator ratio in identifying the tuberculous meningitis and purulent meningitis.Methods: A total of 43 patients with tuberculous meningitis who were admitted in our hospital from August 2015 to July 2017 were included in the study and served as the tuberculous meningitis group. Moreover, 40 cases with purulent meningitis were served as the purulent meningitis group. The morning fasting peripheral venous blood was collected and centrifuged for the plasma. Lumbar puncture was used to collect cerebrospinal fluid. The fully automatic biochemical analyzer was used to detect GSH, the plasma protein, chloride, glucose, lactic acid, and ADA. GSF/plasma ratio was calculated. The immunity transmission turbidity was used to detect GSH and Cys-C. FCM was used to detect CD64. ELISA was used to detect MMP-9.Results:GSF chloride and lactic acid in the tuberculous meningitis group were significantly lower than those in the purulent meningitis group, while ADA was significantly higher than that in the purulent meningitis group. The plasma protein, chloride, and lactic acid in the tuberculous meningitis group were significantly lower than those in the purulent meningitis group, while ADA was significantly higher than that in the purulent meningitis group. ADA ratio in GSF in the tuberculous meningitis group was significantly higher than that in the purulent meningitis group, while chloride and lactic acid ratio was significantly lower than that in the purulent meningitis group. CD64 in GSF in the tuberculous meningitis group was significantly lower than that in the purulent meningitis group, and MMP-9 was significantly higher than that in the purulent meningitis group, while the comparison of Cys-C between the two groups was not statistically significant.Conclusions: GSF, plasma protein, chloride, lactic acid, and ADA concentration ratio in the tuberculous meningitis group and purulent meningitis group have a certain difference. Combined detection of CD64 and MMP-9 contribute to identifying the two meningitis.

Effects of quadruple antituberculous drugs in combination with linezolid and moxifloxacin on CSF cytology, NSE, NGF and its receptors in patients with refractory tuberculous meningitis

Objective: To investigate the effects of linezolid and moxifloxacin combined with quadruple antituberculosis drugs on CSF cytology, NSE (neuronal specific enolase), NGF(nerve growth facor) and its receptors, endothelin and its receptors and CRP (C reaction protein) in patients with refractory tuberculous meningitis. Method: A total of 56 patients were selected with tuberculous meningitis in our hospital from February 2014 to December 2017,randomly divided them into 2 groups, each group was 28 cases, set as the observation group and the control group, both groups were treated with quadruple antituberculosis drugs, the observation group was given ilinezolid on this basis, and the control group was combined with moxifloxacin, The course of treatment was 4 weeks, compared the levels of CSF cytology, NSE, NGF and NGF receptors, endothelin and endothelin receptors, and CRP after treatment in the two groups. Result:The CSF cytology, NSE, NGF and NGF receptors, endothelin and endothelin receptor, and CRP levels remained unchanged before treatment, the difference was not statistically significant. After treatment, the chloride and glucose levels in the observation group were higher than those before treatment and that of the control group, the protein, white blood cell count, and cerebrospinal fluid pressure levels were lower than before treatment and that of the control group, the difference was statistically significant;The NSE level in the observation group after treatment was lower than before treatment and that of the control group, the difference was statistically significant;After treatment, the levels of NGF and its receptors in the observation group were higher than those before treatment and that of the control group, and the levels of endothelin, and its receptor, CRP were lower than those before treatment and that of the control group, the difference was statistically significant. Conclusion:The use of linezolid in combination with quadruple antituberculosis drugs to treat refractory tuberculous meningitis has better clinical effect, effectively improve cerebrospinal fluid cytology, regulate cerebrospinal fluid NSE levels, restore NGF, endothelin and its receptor function, reduce inflammatory response, recommended for clinical promotion and application.

Application Research of Detailed Nursing of Tuberculous Meningitis Patients

Objective:To explore the application effect of detailed nursing in tuberculous meningitis nursing.Methods:A total of 52 patients with tuberculous meningitis who were admitted to our hospital from May 2019 to February 2022 were selected as the research objects,and divided into 25 patients in the control group and 27 patients in the study group according to the random table method,and the compliance,quality of life,recurrence,nursing satisfaction,depression,anxiety and PSQI scores of the two groups were observed and analyzed.Results:In the study group,the number of patients with complete compliance,partial compliance and non-compliance were 13,11 and 3,respectively,and the compliance rate was 88.89%.In the control group,the number of patients with complete compliance,partial compliance and non-compliance were 11,5 and 9,respectively,and the compliance rate was 67.86%,and P<0.05 was considered statistically significant.The quality-of-life score of the control group was 48.36±2.24,which was lower than that of the study group,50.23±2.12,(P<0.05).The rate of recurrence of the control group was 36.00%,which was significantly higher than 7.41%in the study group(P<0.05).There was no significant statistical difference between the SAS,SDS,and PSQI scores of the two groups before nursing,(P>0.05).After nursing,both groups showed a decrease in SDS and SAS scores,with the study group showing significantly lower scores than the control group(P<0.001).Besides,the PSQI dimension scores and total score in the study group were lower than those in the control group(P<0.001).Moreover,the nursing satisfaction of the patients in the study group was significantly higher than that in the control group(93.02%>71.79%),(P<0.05).Conclusion:A full range of detailed care is not only helpful for accurate diagnosis and treatment of patients,but also helps to create a satisfactory hospital environment for patients.Results from this study showed that detailed nursing care for patients with tuberculous meningitis shows a significant positive effect and should be applied in clinical practices.

psk1 virulence gene-induced pulmonary and systemic tuberculosis in a young woman with normal immune function:A case report

BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.

Analytical Optimization of GeneXpert Ultra for Detection of Tuberculosis in CSF Samples

Detection of Mycobacterium tuberculosis complex (MTBC) in extrapulmonary specimens can be challenging due to their paucibacillary nature. This difficulty is especially true for cerebrospinal fluid (CSF), and the low sensitivity and specificity for diagnosis hampers rapid detection and treatment in vulnerable populations. GeneXpert MTB/RIF Ultra has been shown to provide rapid results for detection of MTBC and associated Rifampin resistance, but there is limited data regarding standardized methods for CSF processing on this assay. In this study, we sought to provide guidance regarding the best methods for CSF processing, including optimal volumes to test, length of incubation with sample reagent and finally effects of long-term freezing on detection.

Spondylodiscitis, epidural abscess, and meningitis after transoral robotic surgical resection of a squamous cell carcinoma of the posterior pharyngeal wall

Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.

脑、脑膜、脑神经、脑血管、周围神经受累的结核性脑膜炎一例

目的探讨结核性脑膜炎(TBM)可能出现的并发症、相关机制及治疗方案。方法分析1例诊断为TBM患者的临床症状、并发症及诊疗经过,对相关并发症发病机制进行总结。结果TBM患者可以出现头痛、肢体无力、言语不清、眼球运动障碍、口角歪斜、肢体麻木等脑膜、脑实质、脑神经以及周围神经受累表现。周围神经系统受累可能与感染、炎症浸润、免疫介导机制或抗结核药物相关,多数患者在足量、全疗程抗结核及补充维生素、营养神经等药物治疗后症状改善。结论TBM可累及脑、脑膜、脑神经、脑血管、周围神经,需与其他原因引起的类似症状相鉴别,以指导治疗,改善预后。

脑脊液和血浆中性粒细胞外诱捕网标志物对结核性脑膜炎与化脓性脑膜炎的鉴别诊断价值

目的探讨脑脊液、血浆中性粒细胞外诱捕网(NETs)标志物对结核性脑膜炎与化脓性脑膜炎的鉴别诊断价值。方法选择结核性脑膜炎患者20例纳入结核性脑膜炎组、化脓性脑膜炎患者30例纳入化脓性脑膜炎组、因鉴别诊断需要进行腰椎穿刺术的脑脊液正常患者20例纳入正常对照组。采用ELISA法检测各组脑脊液及血浆NETs标志物[中性粒细胞弹性蛋白酶(NE)-DNA复合物、髓过氧化物酶(MPO)-DNA复合物]。绘制受试者工作特征(ROC)曲线,评价脑脊液、血浆NETs标志物对结核性脑膜炎与化脓性脑膜炎的鉴别诊断价值。结果正常对照组血浆NE-DNA复合物水平比较、结核性脑膜炎组、化脓性脑膜炎组脑脊液MPO-DNA复合物、NE-DNA复合物水平依次增高(P均<0.05)。化脓性脑膜炎组血浆NE-DNA复合物水平高于结核性脑膜炎组和正常对照组(P均<0.05),结核性脑膜炎组与正常对照组比较差异无统计学意义;三组血浆MPO-DNA复合物水平比较差异无统计学意义(P均>0.05)。脑脊液NE-DNA复合物、MPO-DNA复合物鉴别结核性脑膜炎与化脓性脑膜炎的ROC曲线下面积(AUC)分别为0.961、0.945,灵敏度分别为92.36%、89.44%,特异度分别88.35%、85.29%;血浆NE-DNA复合物、MPO-DNA复合物鉴别结核性脑膜炎与化脓性脑膜炎的AUC分别为0.720、0.709,灵敏度分别为84.62%、80.49%,特异度分别为80.18%、73.55%。结论与化脓性脑膜炎比较,结核性脑膜炎患者脑脊液MPO-DNA复合物、NE-DNA复合物水平及血浆NE-DNA复合物水平降低;脑脊液NETs标志物检测可能有助于结核性脑膜炎与化脓性脑膜炎的鉴别诊断。