结核性脑膜炎相关诊断指标分析

新发传染病电子杂志 ›› 2017, Vol. 2 ›› Issue (2): 85-88.

结核性脑膜炎相关诊断指标分析

霍勇军¹, 战云飞², 刘国利², 杨效光², 侯代伦³

1.山东中医药大学附属医院放射科,济南 250014;
2.山东省胸科医院结核内科,济南 250013;
3.山东省胸科医院影像科,济南 250101

收稿日期:2017-02-16 出版日期:2017-05-30 发布日期:2020-07-01
通讯作者: 侯代伦,Email：hodelen@126.com
基金资助:
山东省自然科学基金（ZR2013HM029）

The role of diagnostic indexes in tuberculous meningitis patients

HUO Yong-jun¹, ZHAN Yun-fei², LIU Guo-li², YANG Xiao-guang², Hou Dai-lun³

1. The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;
2. Shandong Provincial Chest Hospital,Jinan 250013,China;
3. Shandong Provincial Chest Hospital,Jinan 250101,China

Received:2017-02-16 Online:2017-05-30 Published:2020-07-01

摘要/Abstract

摘要： 目的探讨结核性脑膜炎血T-SPOT.TB与颅脑MRI诊断指标的意义。方法收集山东中医药大学附属医院和山东省胸科医院确诊的结核性脑膜炎（tuberculous meningitis,TBM）患者（n=40）作为观察组,病毒性脑膜炎（viral meningitis,VM）和新型隐球菌脑膜炎（cryptococcosis meningitis,CM）患者（n=40）作为对照组,检测血T-SPOT.TB、脑脊液腺苷酸脱氨酶（cerebrospinal fluid adenosine deaminase,CSFADA）和脑脊液结核抗体（cerebrospinal fluid tuberculosis antibody, CSFTBAb）,收集临床数据,采用EmpowerStats2.14.9统计软件进行统计学分析两组病人间的差异性,P<0.05具有统计学意义。结果血T-SPOT.TB、CSFADA和CSFTBAb的敏感度、特异度、阳性预测值和阴性预测值分别为0.600,0.950,0.923,0.704;0.500,0.950,0.909,0.655和0.200,0.975,0.889,0.549。血T-SPOT.TB和CSFADA的敏感度明显高于CSFABAb(P<0.001)。血T-SPOT.TB、CSFADA和CSFABAb的特异度、阳性预测值和阴性预测值差异无统计学意义(P>0.05)。脑脊液结核菌PCR和结核菌培养的阳性率(5.0%,2/40;2.5%,1/40)差异无统计学意义(χ2=0.000,P=1.000)。观察组颅脑MRI示脑膜强化占62.5%(25/40),脑膜未强化37.5%(15/40);其中脑积水占15.0% (6/40),脑结核占17.5%(7/40)。结论在结核性脑膜炎的诊断指标中血T-SPOT.TB、CSFADA较CSFABAb具有更高的诊断意义,颅脑影像学对结核性脑膜炎的诊断、治疗和预后具有重要的参考价值。

关键词: 结核性脑膜炎, T-SPOT.TB, 脑脊液, 诊断, 影像学

Abstract: Objective To investigate the role of partial diagnostic indexes in TBM patients. Method TBM patients(group TBM, n=40), non-TBM patients(group NTBM, n=40, 20 viral meningitis patients and 20 cryptococcal meningitis patients) were enrolled in the study. The blood T-SPOT.TB, CSFADA and CSFTBAb were examined and the clinical data were collected. The data were analyzed by the software EmpowerStats 2.14.9, P<0.05 was considered to be statistical significant. Results The sensitivity, specifity, positive predictive values(PPV) and negative predictive values(NPV) of blood T-SPOT.TB, CSFADA and CSFTBAb were respectively 0.600, 0.950, 0.923, 0.704;0.500, 0.950, 0.909, 0.655 and 0.200, 0.975, 0.889, 0.549. The sensitivity of blood T-SPOT.TB and CSF ADA was higher than the CSFTBAb(P<0.001). The specifity, PPV and NPV of the blood T-SPOT.TB, CSFADA and CSFTBAb had no statistical difference(P>0.05). The positive rates of CSF mycobacterium tuberculosis PCR and cultivation(5.0%, 2/40; 2.5%, 1/40) showed no statistical significance(χ²=0.000, P=1.000). The cranial magnetic resonance showed meningeal enhancement occupied 62.5%(25/40), meningeal non-enhancement occupied 37.5% (15/40), hydrocephalus occupied 15.0%(6/40) and tuberculomas occupied 17.5%(7/40). Conclusions Blood T-SPOT.TB and CSFADA have higher diagnostic significance than CSFTBAb in the diagnosis of TBM. The cranial image is important in the diagnosis, therapy and prognosis of tuberculous meningitis.

Key words: Tuberculous meningitis, T-SPOT.TB, Cerebrospinal fluid, Diagnosis, Image

霍勇军, 战云飞, 刘国利, 杨效光, 侯代伦. 结核性脑膜炎相关诊断指标分析[J]. 新发传染病电子杂志, 2017, 2(2): 85-88.

HUO Yong-jun, ZHAN Yun-fei, LIU Guo-li, YANG Xiao-guang, Hou Dai-lun. The role of diagnostic indexes in tuberculous meningitis patients[J]. Electronic Journal of Emerging Infectious Diseases, 2017, 2(2): 85-88.

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