Study On The Diagnostic Value Of ELISPOT Assay Detecting Anti-BCG-IgG Secreting Cells In CSF For Early TBM

Tuberculous meningitis (Tuberculous Meningitis, TBM) is a common disease in nervous system tuberculosis, Delayed diagnosis and treatment can lead to serious neurological complications, and ultimately left disability or death. The incidence of tuberculous meningitis steady declined since the 1960s, but after the 1980s tended to rise. Especially in recent years, frequent movement of the population, the emergence of drug resistance of Mycobacterium tuberculosis, AIDS pandemic and the broad application of immunological agents, making the incidence of TB increased continuously, the incidence of TBM has increased both in developing countries and developed countries.However, in clinical work, early tuberculous meningitis patients are often with untypical clinical manifestations and the cerebrospinal fluid does not change more typical, it is difficult to distinguish the TBM with viral meningitis, purulent meningitis and cryptococcal meningitis. Therefore, it is essential to find a indicate for helping us to diagnose TBM in the forepart of diseases. At present, the"gold standard"diagnosis of tuberculous meningitis is the training or cerebrospinal fluid found in smears of acid-fast bacilli Mycobacterium tuberculosis. Unfortunately, this method has a poor sensitivity, clinical diagnosis and treatment can not be provided timely guidance. In 1983, ELISPOT technique, was establish to detect antibody-secreting cells, with more than 20 years development, the ELISPOT technology has become the highest sensitivity assay of the current detection technology. At present, in China, there was only a few studies on the applications of ELISPOT assay detecting anti-BCG-IgG secreting cells in CSF. In our study, we detected anti-BCG-IgG secreting cells in CSF by ELISPOT assay, and evalue the clinical value for the diagnosis of early TBM.Objective:To detect anti-BCG-IgG secreting cells in CSF by ELISPOT assay and evalue the clinical value for the diagnosis of early TBM.Methods:Patients: During 2007.3-2007.12, to select 30 TBM patients within 14 days after TBM onset, from TBM study and treatment centre of Changchun city and the first hospital of Jilin university, and 30 patients with other infectious diseases of the CNS (controllers) from the first hospital of Jilin university.To get about 4-6ml CSF from each TBM and controllers, then remove some plasma for ELISA assay for detecting the anti-TB antibody and extract the mononuclear cells (MNCs) for ELISPOT assay for detecting B cells producing anti-BCG-IgG in CSF. At last, to compare the result of ELISPOT assay with the result of ELISA assay.Result:1. ELISPOT assay for detecting B cells secreting anti-BCG- IgG in CSF: In the 30 TBM patients, 27 patients were positive and 3 patients were negative, the positive rate was 90%. And in the 30 patients with other infectious diseases of the CNS, no patient was positive.2. ELISA assay for detecting the anti-TB antibody: In the 30 TBM patients, 5 patients were positive and 25 patients were negative, and the 5 positive patients were positive, too, by ELISPOT assay detecting B cells secreting anti-BCG-IgG in CSF. But in the 30 patients with other infectious diseases of the CNS, was positive.ELISPOT assay for detecting B cells secreting anti-BCG-IgG in CSF was more sensitive than the ELISA assay for detecting the anti-TB antibody.Conclusion:ELISPOT assay for detecting B cells secreting anti-BCG-IgG in CSF was a effective auxiliary examination to the diagnosis of TBM in earlier period.