结核杆菌IFN-γ在结核性脑膜炎鉴别诊断中的应用  

Application of Mycobacterium Tuberculosis IFN-γresponses in Differential Diagnosis of Tuberculous Meningitis

作　　者：林正豪[1] 曾剑锋[2] 刘国辉[2] 

机构地区：[1]深圳市第三人民医院神经内科,广东深圳518112 [2]深圳市第三人民医院结核科,广东深圳518112

出　　处：《中国医药指南》2013年第10期4-4,8,共2页Guide of China Medicine

基　　金：深圳市科技计划项目(编号:201202062)

摘　　要：目的探讨外周血结核杆菌抗原特异性γ干扰素水平在结核性脑膜炎与隐球菌性脑膜炎鉴别诊断中的作用。方法回顾性分析本院13例菌阳结核性脑膜炎、15菌阴结核性脑膜炎及11例隐球菌性脑膜炎患者外周血结核杆菌抗原特异性γ干扰素水平差异。结果菌阳结核性脑膜炎患者外周血结核杆菌抗原特异性γ干扰素9例阳性,4例阴性,阳性率69.2%,菌阴结核性脑膜炎患者外周血结核杆菌抗原特异性γ干扰素10例阳性,5例阴性,阳性率66.7%,隐球菌性脑膜炎患者外周血结核杆菌抗原特异性γ干扰素1例阳性,10例阴性,阳性率0.09%,列联表资料的χ2检验(χ2=6.78,P=0.001),三组阳性率有差别,经组间两两比较,菌阳结核性脑膜炎与菌阴结核性脑膜炎阳性率无显著性差异(χ2=4.31,P=0.07),菌阳结核性脑膜炎与隐球菌性脑膜炎阳性率有显著性差异(χ2=7.37,P=0.013),菌阴结核性脑膜炎与隐球菌性脑膜炎阳性率有显著性差异(χ2=8.26,P=0.024)。结论外周血结核杆菌抗原特异性γ干扰素检测可作为结核性脑膜炎与隐球菌性脑膜炎早期鉴别诊断的辅助手段。Objective To discuss clinical application of Mycobacterium tuberculosis antigen specific IFN-γ,responses in antidiastole between tuberculous meningitis and cryptococal neoformans meningitis. Methods IFN-γ responses in peripheral blood of 13 patients with csf positive tuberculous meningitis, 15 patients with csf negative tuberculous meningitis and 11 patients with cryptococal neoformans meningitis were tested and then analyzed retrospectively. Results Positive IFN-γ responses were detected in 69.2%（9/13）of patiems with csf positive tuberculous meningitis, 66.7%（10/15）of patients with csf negative tuberculous meningitis and 9.0%（1/11） of patients with cryptococal neoformans meningitis. IFN-γresponses in the three groups is statistically different（x2 =6.78,P=-0.001）. Through the comparison between the two two groups, IFN-γ responses positive rate between csf positive tuberculous meningitis patients and csf negative tuberculous meningitis patients is not statistically different（z2=4.31,P=0.07）. IFN-γ responses positive rate between csf positive tuberculous meningitis patients and cryptococal neoformans meningitis patients is statistically different（x2=7.37,P=0.013）. IFN-γ responses positive rate between csf negative tuberculous meningitis patients and cryptococal neoforrnans meningitis patients is statistically different（x2=8.26,P=0.024）.Conclusion IFN- γ esponses in peripheral blood can be used as an assistant means to discriminate cryptococal neoformans meningitis from tuberculous meningitis.

关 键 词：脑膜炎 结核 隐球菌 Γ干扰素 诊断 

分 类 号：R515.2[医药卫生—内科学]