结核性脑膜炎脑脊液结核分枝杆菌抗原的动态变化分析  

The dynamic changes of mycobacterium tuberculosis antigens in the cerebrospinal fluid of patients with tuberculous meningitis

作　　者：宋孚霞[1] 孙旭文[1] 王晓彤[1] 佴玉[1] 刘宏[1] 

机构地区：[1]烟台毓璜顶医院神经内科,山东省烟台市264000

出　　处：《中国神经免疫学和神经病学杂志》2011年第2期119-121,共3页Chinese Journal of Neuroimmunology and Neurology

基　　金：烟台市科技发展计划(2009155-2)

摘　　要：目的探讨结核性脑膜炎(结脑)脑脊液结核分枝杆菌(MTB)抗原的动态变化。方法对临床诊断为结脑及病毒性脑膜炎(病脑)的患者各30例进行脑脊液MTB抗原动态分析,分别于发病第1、2、4周进行脑脊液单核细胞MTB抗原免疫组织化学染色,进行阳性细胞计数并统计阳性病例数。结果结脑组第1周脑脊液MTB抗原阳性27例(90%),阳性细胞比例(22.6±1.6)%,第2周阳性27例(90%),阳性细胞比例(21.8±2.1)%,第4周阳性9例(30%),阳性细胞比例(10.5±1.1)%;第1、2周MTB抗原阳性率及阳性细胞比例明显高于第4周(P<0.01)。病脑组第1周MTB抗原阳性3例(10%),阳性细胞比例为(5.2±1.3)%,第2、4周检测结果均为阴性。结脑组第1周较病脑组MTB抗原阳性例数及阳性细胞比例明显升高(P<0.01)。MTB抗原检测早期结脑(发病2周内)敏感性、特异性均达90%。结论脑脊液MTB抗原检测有助于结脑的早期诊断。Objective To investigate the dynamic changes of mycobacterium tuberculosis（MTB） antigens in the cerebrospinal fluid（CSF） monocytes of the patients with tuberculous meningitis（TBM） or viral meningitis.Methods Thirty inpatients with TBM and 30 with viral meningitis were studied at the first,second and fourth week of their treatment.Immunohistochemical assay were used to detect the number of MTB antigen positive cells,and that of positive cases were recorded.Results In the 30 TBM patients,27 showed positive in the first week（90%）,the percentage of positive cells was（22.6±1.6）%;in the second week,the 27 patients still showed positive（90%）,the percentage of positive cells was（21.8±2.1）%,and in the fourth week,only 9 patients showed positive（30%）,the percentage of positive cells was（10.5±1.1）%.The percentage of positive cases and positive cells both were higher in the first and second week than in the fourth week in TBM patients（P0.01）.Only 3 viral meningitis patients（10%） showed positive in the first week,while all negative in the second and fourth week after repeated detection,and the positive cells percentage was（5.2±1.3）%.The percentage of positive cases and positive cells were higher in TBM patients than in viral meningitis in the first week（P0.01）.The diagnostic sensitivity and specificity both were 90% on the early stage（within two weeks） TBM based on the MTB antigens detection.Conclusions Early detecting of MTB antigens in the CSF is helpful for the early diagnosis of TBM.

关 键 词：结核性脑膜炎 结核 分枝杆菌抗原 诊断 

分 类 号：R529.3[医药卫生—内科学] R446.141[医药卫生—临床医学]