IL-33和ADA水平在结核性脑膜炎病程中的动态变化及意义  

Dynamic changes and significance of interleukin-33 and adenosine deaminase levels in course of tuberculous meningitis

作　　者：凌再芹[1] 孔海丽 朱峰[1] 李磊[1] LING Zaiqin;KONG Haili;ZHU Feng;LI Lei(Department of Tuberculosis Internal Medicine,Shandong Provincial Chest Hospital,Jinan,Shandong 250101,China)

机构地区：[1]山东省胸科医院结核内科,济南250101

出　　处：《重庆医学》2021年第12期2089-2092,2096,共5页Chongqing medicine

摘　　要：目的探讨白细胞介素-33(IL-33)、腺苷脱氨酶(ADA)水平在结核性脑膜炎病程中的动态变化及意义。方法选取2017年3月至2019年2月该院结核内科收治的176例脑膜炎患者为研究对象。其中结核性脑膜炎患者46例为结核性脑膜炎组,化脓性脑膜炎患者48例为化脓性脑膜炎组,病毒性脑膜炎患者39例为病毒性脑膜炎组。以头痛为主诉而脑脊液正常患者43例为头痛症状组。采用ELISA法检测各组患者脑脊液IL-33、ADA水平,Pearson进行相关性分析,受试者工作特征(ROC)曲线分析诊断价值。结果结核性脑膜炎组患者脑脊液中IL-33、ADA水平明显高于化脓性脑膜炎组、病毒性脑膜炎组、头痛症状组(P<0.05)。治疗6周后结核性脑膜炎患者脑脊液中IL-33、ADA水平明显低于治疗4周后、治疗2周后、入院当天(P<0.05)。结核性脑膜炎患者脑脊液中IL-33与ADA水平呈正相关(P<0.05)。IL-33、ADA联合鉴别诊断结核性脑膜炎的曲线下面积(AUC)为0.870(95%CI:0.790~0.949),特异度为95.8%,灵敏度为76.1%。结论脑脊液IL-33、ADA水平可作为鉴别诊断结核性脑膜炎及病情好转的参考指标。Objective To investigate the dynamic changes and significance of interleukin-33(IL-33)and adenosine deaminase(ADA)in the course of tuberculous meningitis.Methods A total of 176 cases of tuberculous meningitis in the tuberculosis internal medicine department of this hospital from March 2017 to February 2019 were selected as the study subjects,46 cases of tuberculous meningitis served as the tuberculous meningitis group,48 cases of purulent meningitis as the purulent meningitis group and 39 cases of viral meningitis as the viral meningitis group.Forty-three cases of headache as the chief complaint and normal rebrospinal fluid(CSF)served as the headache symptom group.ELISA was adopted to detect the levels of IL-33 and ADA in spinal fluid.The correlation analysis was performed by Pearson and the diagnostic value was analyzed by using the receiver operating characteristic(ROC)curve.Results The levels of cerebrospinal fluid IL-33 and ADA in the tuberculous meningitis group were significantly higher than those in the purulent meningitis group,viral meningitis group and headache symptom group(P<0.05);the levels of cerebrospinal fluid IL-33 and ADA after 6-week treatment in the patients with tuberculous meningitis were significantly lower than those after 4-week treatment,2-week treatment and on the day of admission(P<0.05);there was a positive correlation between the IL-33 level and ADA level in cerebrospinal fluid of the patients with tuberculous meningitis(P<0.05).The area under the curve(AUC)of IL-33 and ADA for diagnosing tuberculous meningitis was 0.870(95%CI:0.790-0.949),the specificity was 95.8%and the sensitivity was 76.1%.Conclusion The levels of cerebrospinal fluid IL-33 and ADA can serve as the reference indexes for the differential diagnosis and improvement of tuberculous meningitis.

关 键 词：结核性脑膜炎 脑脊液 白细胞介素-33 腺苷脱氨酶 动态变化 

分 类 号：R529.3[医药卫生—内科学]