结核性脑膜炎伴发肺结核的临床研究及检验方法的对比  

Analysis of clinical features and assessment of diagnostic methods of tuberculous meningitis with pulmonary tuberculosis

作　　者：陈颜强[1] 赵青[2] 李薇[1] 孟艺哲 李敬[1] 李军霞[1] CHEN Yan-qiang;ZHAO Qing;LI Wei;MENG Yi-zhe;LI Jing;LI Jun-xia(Department of Neurology,Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Emergency,Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院神经内科,河北石家庄050041 [2]河北省胸科医院急诊科,河北石家庄050041

出　　处：《河北医科大学学报》2019年第5期504-507,共4页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题(20150139)

摘　　要：目的分析结核性脑膜炎伴发肺结核的临床特点以及脑脊液(cerebrospinal fluid,CSF)改良抗酸染色、结核菌抗体(tuberculosis bacterium antibody,TB-Ab)、结核菌素皮试试验(tuberculin skin test,TST)、干扰素γ释放试验(interferon-gamma release assays,IGRAs)诊断该病的优劣。方法收集结核性脑膜炎患者66例为结核性脑膜炎组(A组),不伴肺结核的其他中枢神经系统疾病患者60例为非结核性脑膜炎组(B组),将结核性脑膜炎组中伴发粟粒性肺结核28例设为结核性脑膜炎伴发粟粒性肺结核组(C组),不伴粟粒性肺结核的38例设为单纯结核性脑膜炎组(D组),比较A组与B组、C组与D组之间CSF改良抗酸染色、TB-Ab、TST及IGRAs检出阳性率,CSF改良抗酸染色、TB-Ab、TST、IGRAs的敏感度、特异度、阳性预测值及阴性预测值。比较C组与D组临床疗效。结果 A组CSF改良抗酸染色阳性率、结核抗体检出阳性率、TST强阳性率和IGRAs阳性率均高于B组(P<0.05);C组与D组CSF改良抗酸染色阳性率、TB-Ab阳性率和TST强阳性率差异均无统计学意义(P>0.05),C组IGRAs阳性率显著高于D组(P<0.05)。敏感度:IGRAs>TB-Ab>CSF改良抗酸染色>TST;特异度:CSF改良抗酸染色>TST>IGRAs>TB-Ab;阳性预测值:CSF改良抗酸染色>IGRAs>TST>TB-Ab;阴性预测值:IGRAs>TB-Ab>CSF改良抗酸染色>TST。C组与D组好转率差异无统计学意义(P>0.05)。结论结核性脑膜炎伴发粟粒性肺结核患者发病年龄小,对于病原学检查阴性的可疑结核性脑膜炎伴发粟粒性肺结核患者,IGRAs可作为首选检验方法。Objective To analyze the clinical characteristics of tuberculous meningitis associated with tuberculosis and the advantages and disadvantages of improved acid-fast staining of cerebrospinal fluid(CSF),tuberculosis bacterium antibody(TB-Ab),tuberculin skin test(TST)and interferon-gamma release assays(IGRAs)in the diagnosis of tuberculous meningitis.Methods Sixty-six cases of tuberculous meningitis were collected as tuberculous meningitis group(group A),60 cases of other central nervous system diseases without tuberculosis as non-tuberculous meningitis group(group B).Twenty-eight cases of tuberculous meningitis with miliary tuberculosis were divided into tuberculous meningitis with miliary tuberculosis group(group C)and 38 cases without miliary pulmonary conjunctiva into tuberculosis group(group D).The sensitivity,specificity,positive predictive value and negative predictive value of CSF improved acid-fast staining,TB-Ab,TST and IGRAs in group A and group B were calculated,and the positive rates of CSF improved acid-fast staining,TB-Ab,TST and IGRAs in group C and group D were compared.The clinical effects of group C and group D were compared.Results The positive rate of modified acid-fast staining,tuberculosis antibody detection,TST strong positive rate and IGRAs positive rate of CSF in group A were higher than those in group B(P<0.05).There was no significant difference in the positive rate of CSF improved acid-fast staining,tuberculosis antibody and TST between group C and group D(P>0.05).The positive rate of IGRAs in group C was significantly higher than that in group D(P<0.05).The sensitivity was IGRAs>TB-Ab>CSF improved acid-fast staining>TST.Specificity was CSF improved acid-fast staining>TST>IGRAs>TB-Ab.Positive predictive value was CSF improved acid-fast staining>IGRAs>TST>TB-Ab.Negative predictive value was IGRAs>TB-Ab>CSF improved acid-fast staining>TST.There was no significant difference in the improvement rate between group C and group D(P>0.05).Conclusion The age of onset of tuberculous meningitis wit

关 键 词：结核 脑膜 结核 肺 干扰素γ释放试验 诊断 

分 类 号：R529.3[医药卫生—内科学] R521[医药卫生—临床医学]