不同方法诊断结核性脑膜炎的价值比较  

Comparison of the different methods in the diagnosis of tuberculous meningitis

作　　者：张春艳[1] 池菲[1] 张新[2] 张秀敏[1] 孙金昊[3] 

机构地区：[1]河北省胸科医院急诊科,石家庄050000 [2]河北省胸科医院呼吸科,石家庄050000 [3]河北省胸科医院结核科,石家庄050000

出　　处：《疑难病杂志》2017年第4期356-359,363,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的评价结核菌素试验(PPD)、结核抗体(38KDa抗体、16KDa抗体、LAM抗体)、外周血γ-干扰素释放试验、脑脊液腺苷脱氨酶(ADA)、血清ADA、脑脊液抗酸染色、脑脊液结核菌培养早期诊断结核性脑膜炎的临床价值。方法纳入2013年1月—2016年7月河北省胸科医院收治的结核性脑膜炎患者62例和非结核性脑膜炎患者60例,采用7种方法检查结核性脑膜炎阳性率,绘制各诊断方法ROC曲线,计算曲线下面积,比较各种方法的敏感度、特异度、准确度、阳性似然比、阴性似然比及约登指数。结果外周血γ-干扰素释放试验的ROC曲线下面积为0.893,血清及脑脊液ADA亦有较高的曲线下面积,分别为0.794和0.812。根据ROC曲线得出血清.ADA最佳cut-off值为17.3 U/L,脑脊液ADA最佳cut-off值为7.61 U/L。比较7种检测方法得出外周血γ-干扰素释放试验敏感度和特异度分别为90.3%、88.3%,约登指数0.786,准确度89.3%。血清ADA敏感度和特异度分别为80.6%、70.0%,约登指数0.506,准确度75.4%。脑脊液ADA敏感度和特异度分别为61.3%、90.0%,约登指数0.513,准确度75.4%。结论干扰素释放试验对于结核性脑膜炎早期诊断价值最高,血清及脑脊液ADA也有较好的准确度。Objective To evaluate the clinical value of PPD and tuberculosis antibody （38KDa antibody, 16KDa antibody, LAM antibody） , peripheral blood interferon gamma release test, cerebrospinal fluid ADA, serum ADA and cerebrospinal fluid cerebrospinal fluid acid fast stain, bacterial culture in early diagnosis of tuberculous meningitis. Methods Se- lected 62 cases of tuberculous meningitis and 60 cases of others. The positive rate in tuberculous meningitis was detected by seven methods. We draw ROC curve of diagnosis methods, calculate the area under ROC curve, and compare of sensitivity, specificity, accuracy, positive and negative likelihood ratio, Youden index in different methods. Results The area under ROC curve ofγinterferon release experiment in the peripheral blood was 0. 893. ADA in serum and cerebrospinal fluid has a higher area under the curve, namely 0. 794 and 0. 812. Under the ROC curves obtained serum ADA best point was 17.3 U/ L, cerebrospinal fluid ADA best point was 7.61 U/L. The sensitivity and specificity of＇yinterferon release test were 90.3% and 88.3% , Youden index was 0. 786, and accuracy was 89.3%. The sensitivity and specificity of serum ADA were 80.6% and 70.0% , Youden index was 0. 506, and accuracy was 75.4%. The sensitivity and specificity of cerebrospinal fluid ADA were 61.3% and 90.0% , Youden index was 0. 513, and accuracy was 75.4%. The above 3 methods are better than other meth- ods. Conclusion Interferon release test has high value for early diagnosis of tuberculous meningitis, and serum ADA and cerebrosplnal fluid ADA also has good accuracy.

关 键 词：脑膜炎 结核性 腺苷脱氨酶 Γ-干扰素 结核抗体 

分 类 号：R529.3[医药卫生—内科学]