脑脊液宏基因组二代测序联合结核抗体、鸟苷酸结合蛋白1在诊断结核性脑膜炎中的价值研究  

Study on the Value of Cerebrospinal Fluid Metagenomic Second-Generation Sequencing Combined with Tuberculosis Antibody and Guanylate Binding Protein 1 in Diagnosis of Tuberculous Meningitis

作　　者：刘银银 覃玉术 孟开武 LIU Yinyin;TAN Yushu;MENG Kaiwu(Department of Neurology,302 Hospital of China Guihang Group,Anshun City,Guizhou Province 561000;不详)

机构地区：[1]中国贵航集团三〇二医院神经内科,贵州省安顺市561000 [2]黔南州人民医院神经内科

出　　处：《医学理论与实践》2025年第7期1086-1089,共4页The Journal of Medical Theory and Practice

基　　金：通用医疗科研基金项目(TYYLKYJJ-2022-040)。

摘　　要：目的:探讨脑脊液宏基因组二代测序(mNGS)联合结核抗体、鸟苷酸结合蛋白1(GBP1)在诊断结核性脑膜炎(TBM)中的价值。方法:前瞻性选取2019年1月—2023年11月医院收治的148例疑似TBM患者,按照2010年结核性脑膜炎国际专家共识诊断标准,86例为TBM(TBM组)、62例为非TBM(非TBM组)。收集两组基本资料并检测其脑脊液mNGS阳性情况、脂阿拉伯甘露聚糖(LAM)-IgG结核抗体阳性情况、GBP1相对表达量。分析影响TBM发生的影响因素,以及脑脊液mNGS阳性、结核抗体LAM-IgG阳性、GBP1相对表达量在诊断TBM中的价值。结果:logistic回归分析显示脑脊液葡萄糖水平低、脑脊液mNGS阳性、脑脊液结核抗体LAM-IgG阳性、脑脊液GBP1相对表达量高是影响TBM发生的危险因素(P<0.05)。ROC曲线分析结果显示,脑脊液mNGS阳性、结核抗体LAM-IgG阳性、GBP1相对表达量及三者联合诊断TBM的灵敏度分别为75.58%、73.26%、69.76%、89.53%,特异度分别为80.65%、82.26%、62.90%、93.55%,AUC分别为0.818、0.780、0.714、0.919。结论:脑脊液mNGS阳性、结核抗体LAM-IgG阳性、GBP1相对表达量联合诊断TBM效能良好。Objective:To investigate the diagnostic value of cerebrospinal fluid metagenomic second generation sequencing(mNGS)combined with tuberculosis antibody and guanylate binding protein 1(GBP1)in tuberculous meningitis(TBM).Methods:148 suspected TBM patients admitted to the hospital from January 2019 to November 2023 were prospectively selected,and according to the 2010 international expert consensus diagnostic criteria for tuberculous meningitis,86 cases were confirmed as TBM(TBM group)and 62 cases were confirmed as non-TBM(non-TBM group).The basic data of the two groups were collected and the positive information of mNGS,the positive information of LAM-IgG tuberculosis antibody and the relative expression level of GBP1 in the cerebrospinal fluid were detected.The factors influencing the occurrence of TBM and the positive information of mNGS,the positive information of LAM-IgG tuberculosis antibody and the relative expression level of GBP1 in cerebrospinal fluid were analyzed.Results:Logistic regression analysis showed that cerebrospinal fluid glucose level was low and cerebrospinal fluid mNGS was positive,cerebrospinal fluid was positive for tuberculosis antibody LAM-IgG,and the relative expression level of GBP1 was high were the risk factors for TBM occurrence(P<0.05).ROC curve analysis results showed the positive information of mNGS,the positive information of LAM-IgG tuberculosis antibody and the relative expression level of GBP1 in cerebrospinal fluid and the sensitivity of their combined diagnosis of TBM were 75.58%,73.26%,69.76%,89.53%,the specificity was 80.65%,82.26%,62.90%,93.55%,the AUC were 0.818,0.780,0.714,0.919.Conclusion:The relative expression levels of GBP1 in cerebrospinal fluid combined with LAM-IgG and mNGS positive were effective in the diagnosis of TBM.

关 键 词：脑脊液 宏基因组二代测序 结核抗体 鸟苷酸结合蛋白1 结核性脑膜炎 诊断 

分 类 号：R741.04[医药卫生—神经病学与精神病学]