小儿结核性脑膜炎不同检测方法诊断价值研究  

Clinical diagnostic value of different methods for tuberculous meningitis in children

作　　者：刘彦轩[1] 刘秋君[2] 贾安奎[1] 郭盛菊[1] 石太新[1] 尚好珍 

机构地区：[1]新乡医学院第一附属医院,河南新乡453100 [2]新乡医学院三全学院,河南新乡453000 [3]河南省结核病医院,河南卫辉453100

出　　处：《中国实用儿科杂志》2012年第12期922-924,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨不同实验室检查方法对小儿结核性脑膜炎(TBM)的诊断价值,为其早期诊断寻求方法。方法收集2009年3月至2011年2月新乡医学院第一附属医院结核内科和小儿内科的TBM住院患儿30例,另将同期在该院小儿内科诊断为非结核菌感染的脑炎、脑膜炎或其他脑部病变的30例住院患儿设为对照组。对两组患儿运用荧光定量PCR(FQ-PCR)技术检测脑脊液(CSF)中结核DNA、结核抗体、抗酸杆菌涂片、结核菌培养、腺苷脱氨酶(ADA)活性5种方法进行检测,并将结果进行比较分析。结果 FQ-PCR阳性率与抗酸杆菌涂片、结核菌培养、结核抗体检测差异均有统计学意义(P<0.05);30例TBM患者ADA值升高14例,对照组有6例升高,敏感性与FQ-PCR差异无统计学意义,但特异性(80%)低于FQ-PCR(100%),差异有统计学意义。涂片法和培养法对脑脊液检出率差异无统计学意义。FQ-PCR和ADA两种方法的TBM组和对照组之间差异均有统计学意义。结论 FQ-PCR检测脑脊液结核DNA,简便、快速、敏感性高、特异性强,有助于早期诊断。Objective To explore diagnostic value of 5 methods and to seek an appropriate method for the diagnosis of tuberculous meningitis（TBM）in children. Methods A total of 60 children were included in the study.They were divid- ed into two groups： children with TBM （30）and control group（30）. Cerebrospinal fluid （CSF）samples from patients of each group were detected by 5 methods and then the sensibility and specifcity were statistically analyzed. Results FQ-PCR positive rate of acid-fast bacilli smears and TB cultures, TB-Ab test showed statistically difterence （P 〈 0.05 ）, ADA in 30 cases of tuberculous meningitis increased in 14 cases of 30 TBM patients, and in 6 cases of the control group; the sensitivity was of no significant difference, but the specificity （90%）was lower than the FQ-PCR （100%）, the differ- ence being statistically significant. Smear and culture of cerebrospinal fluid detection rate was not statistically different. The difference of FQ-PCR and ADA in tuberculous meningitis group and control group were statistically significant. Conclusion It is suggested FQ-PCR detection of TB-DNA in CSF is simple, rapid and highly sensitive and specific, which will help early diagnose tuberculous meningitis.

关 键 词：实时荧光定量聚合酶链反应 结核性脑膜炎 脑脊液 

分 类 号：R72[医药卫生—儿科]