The Value Of GeneXpert,T-SPOT.TB Detection Combined With Cranial MRI In The Early Diagnosis Of Tuberculous Meningitis

ObjectiveTo explore the value of early diagnosis of tuberculous meningitis by the combination of Gene Xpert detection,T-SPOT.TB detection technology and cranial MRI,so as to provide a more timely,accurate and effective diagnostic method for tuberculous meningitis.MethodsCerebrospinal fluid was collected from 70 cases of patients diagnosed with tuberculous meningitis and 30 cases of patients with non-tuberculous meningitis in Shenyang chest hospital for liquid culture of tuberculous bacteria MGIT960,cerebrospinal fluid Gene Xpert detection and peripheral blood T-SPOT.TB detection,and tuberculosis antibody detection,PPD test,cerebrospinal fluid routine biochemical tests,cerebrospinal fluid acid fast bacilli smear,cerebrospinal fluid examination such as LAMP testing,calculation of various detection methods positive rate;The clinical symptoms and signs of the two groups were analyzed.The routine and biochemical indexes of CSF in the two groups were compared.To keep positive cerebrospinal fluid tuberculosis bacterium culture liquid to the gold standard for diagnosis of TBM,calculation of cerebrospinal fluid Gene Xpert,peripheral blood T-SPOT.TB testing and the joint degree of sensitivity in the diagnosis of TBM,specific,misdiagnosis rate,missed diagnosis,positive predictive value,negative predictive value,some index and accuracy,and cerebrospinal fluid Gene Xpert device are calculated respectively and the peripheral blood T-SPOT.TB both joint detection after the parallel and series detection efficiency to the diagnosis of TBM,joint cranial enhanced MRI to evaluate the value of early diagnosis of tuberculous meningitis.ResultsThe sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive value,negative predictive value,jorden index and accuracy of Gene Xpert test in this study were 82.61%,100%,0,17.39%,100%,95.06%,0.83 and 96%,respectively.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive value,negative predictive value,Jordan index and accuracy of T-SPOT.TB test were 87.32%,89.66%,10.34%,12.68%,95.38%,74.29%,0.77 and 88%,respectively.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive value,negative predictive value,jorden index and accuracy of the combined detection in the shunt test were 92.96%,89.66%,10.34%,7.04%,95.65%,83.87%,0.83 and 92,respectively.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive value,negative predictive value,jorden index and accuracy of the tandem test were 57.69%,100%,0,42.31%,100%,87.06%,0.58 and 89%,respectively.In this study,90 patients underwent cranial contrast-enhanced MRI,and 9 patients(9/90,10.00%)presented with single enhanced intracranial tuberculous nodules and tuberculoma changes.There was a single case of pia thickening and strengthening(1/90,1.11%).There were 3 cases(3/90,3.33%)in which intracerebral effusion and ventricular dilatation were found alone.There were 16 cases(16/90,17.78%)of cranial MRI changes with parenchymal encephalitis alone.37 cases(37/90,41.11%)who presented with two or more of the above imaging characteristics at the same time.Cranial MRI showed no abnormality in 24 cases(24/90,26.67%).Among the patients with two or more of the above imaging feature changes that were mainly MRI manifestations,1 patient presented positive Gene Xpert test,18 patients presented positive T-SPOT.TB test,and 11 patients presented positive Gene Xpert and T-SPOT.TB test.There was 1 case with positive detection of both Gene Xpert and T-SPOT.TB.ConclusionsGene Xpert and T-SPOT.TB detection were more valuable than PPD test,tuberculosis antibody,cerebrospinal fluid bacteriological examination and LAMP.The sensitivity of T-SPOT.TB parallel detection of Gene Xpert in junction TBM diagnosis was higher than that of the detection alone.The specificity of Gene Xpert combined T-SPOT.TB series test and Gene Xpert alone test was up to 100%.The series test of Gene Xpert combined with T-SPOT.TB detection can reduce the misdiagnosis rate of TBM,and the parallel test can reduce the missed diagnosis rate.Some patients with tuberculous meningitis may have some specific changes in cranial contrast-enhanced MRI,but TBM cannot be excluded in patients without abnormalities in cranial MRI.Gene Xpert and T-SPOT.TB detection combined with cranial enhanced MRI is more valuable for early diagnosis of TBM.