The Clinical Value Of Xpert MTB/RIF Technique In The Early Diagnosis Of Tuberculous Meningitis

Objective: To investigate the value of clinical diagnosis for detection of tuberculous meningitis / rifampicin resistance gene(Xpert MTB / RIF)in tuberculous meningitis(TBM)and other related factors,such as the time of onset,the contact history of tuberculosis,clinical manifestations,cerebrospinal fluid(CSF)examination,and imaging examination and other factors’ significance in early diagnosis of TBM.Methods: 103 cases of intracranial infection in The second Clinical Hospital of Shanxi Medical University and Fourth People’s Hospital of Taiyuan(Tuberculosis Hospital)from January 2015 to August 2017 were collected,including 83 patients with final diagnosis as tuberculous meningitis and 20 patients finally excluded from tuberculous meningitis,the detection of Mycobacterium tuberculosis(MTB)was analyzed by Xpert MTB / RIF Technology,Mycobacterium tuberculosis culture,and acid-fast staining,and other related factors on early diagnosis of TBM were analyzed.Results: Clinical diagnosis was taken as gold standard,tuberculous meningitis was diagnosed by xpert MTB / RIF technique,the sensitivity was 16.9%,the specificity was 100 %,and the false negative rate was 83.1 %,the false positive rate was 0 %.Tuberculous meningitis was diagnosed by mycobacterium tuberculosis culture,the sensitivity was 8.4 %,the specificity was 100 %,the false negative rate was 91.6 %,and the false positive rate was 0 %.Tuberculous meningitis was diagnosed by acid-fast staining,the sensitivity was 2.4 %,the specificity was 100 %,the false negative rate was 97.6 %,and the false positive rate was 0 %.The CSF of 83 patients with final diagnosis as tuberculous meningitis was detected by Xpert MTB / RIF technique,Mycobacterium tuberculosis culture and acid-fast staining.The detection cases of Mycobacterium tuberculosis were 14,7 and 2,respectively.The positive rates were 16.9 %,8.4 % and 2.4 %,respectively,and the positive rates of the three methods were compared,P < 0.05.Analysis of single factor: the clinical symptoms of early diagnosis of TBM were fever,neck rigidity,convulsion and cerebral palsy(P < 0.05).Cerebrospinal fluid examination showed clear appearance,lymphocyte > 50 %,protein > 1g / L(P < 0.05);imaging examination of the brain showed enhancement signal of meninge and high signal of skull base before enhancement CT(P < 0.05).Chest X-rays showed active tuberculosis and tuberculous foci was found in the imaging of CT / MRI / ultrasound outside the CNS(P < 0.05);symptoms persisted for more than 5 days,weight loss,contact history of pulmonary tuberculosis or positive patients in tuberculin subcutaneous test in the past year(P < 0.05).Multivariate logistic analysis: the index with statistical value in the analysis of single factor was included in the analysis of multiple factors.The results showed: Fever(OR:12.651、CI:1.745-91.725、P<0.05),neck rigidity(OR 值:9.185、CI:1.761-47.894、P<0.05),protein in the cerebrospinal fluid > 1 g /L(OR 值:4.793、CI:1.020-22.514、P<0.05),chest X-ray showed active tuberculosis(OR 值:5.901、CI:1.055-33.012、P<0.05),and the appearance of cerebrospinal fluid(CSF)was clear(OR 值:5.367、CI:1.070-26.920、P<0.05),these were independent factors affecting the early diagnosis of TBM.Conclusion: The Xpert MTB / RIF technique was compared with the tuberculous culture and acid staining,it was more conducive to the early diagnosis of tuberculous meningitis.For tuberculous meningitis,there are many factors that affect early diagnosis,and clinical workers should strengthen the recognition and attention of TBM and carry out comprehensive diagnosis by attaching clinical manifestations and various examination results to improve the early diagnosis and treatment rate of tuberculous meningitis.