| Tuberculous Meningitis (TBM) is the non-purulent inflammation caused by Tubercle Bacillus. And the immunologic mechanism is involved in the development of TBM .The earlier clinical manifest of TMB is not typical in general. It is`t easy that to diagnose the TBM definitely in the earlier period of diseases, especially to distinguish the TBM with Viral Meningitis. The missing or mistaken diagnose and therapy in TMB would lead to losing the best opportunity for therapy, even cause the non-reversible phathological changes. Thus , it is essential to find a indicate for helping us to diagnose TBM in the forepart of diseases.. Furthermore , we found that the level of Adenosine Deaminase (ADA) always increased in the Cerebrospinal Fluid( CSF) of the patients with TBM , and that it was closely related with the proliferation capacity of T cells . To determined the definitely relation between the level of ADA in CSF of patients with TBM and the occurring and development of diseases , we had done the following experiment . In the our studies ,we select the 50 patients as the objects . Which had been diagnosed as TBM for 3-5d, and all of them had contacted with the patients with TB , had typical clinical manifests and meninges stimulating symptom, the changed general test of CSF, or with TB in other organs. At the same time , we select 30 patients with Viral Meningitis (VM)and 20 normal peoples as control . We had measured the level of ADA and anti-TB antibodies in the CSF by the biochemical methods or ELISA, respectively. And we analysis the data with statistics methods. Results showed that although the anti-TB antibody positive ratio were 80.39% in the early of diseases, the followed clinical observation showed that the positive ratio were 100% ,but negative in all patients with VM and all normal controls. It indicated all TBM patients had been infected by TB, and the other two groups has never. Similarly, the level of ADA in CSF of all patients increased markedly compared with the Viral infected group (P<0.05) and the normal (P<0.01). And the level of ADA in CSF had no distinct difference between the VM group and the normal . The average of the ADA level in TBM groups is 13.20±1.48 U/L , and 8.59±1.63U/L in the Viral infected group , 8.13±1.05U/L in the normal group. Analysis of the level of ADA compared with the level of PPD-IgG in CSF showed thatthere were 2 patients whose ADA level increased but were lower than the diagnose standard of 10 patients who were negative in PPD-IgG testing in the early period of diseases , the others were all increased distinctly. Simultaneous PPD-IgG testing showed that there were 6 patients were negative ,4 were less positive. It might be caused by the lower immunity of patients afflicted with TBM ,or by the lower virulence and amount of Tubercle Bacillus .The results that the notable increasing of ADA in TBM group demonstrated that ADA increased rapidly in the earlier of the diseases compared with the normal , but not increased in patients with the VM . Since the activity testing of ADA in CSF were specific and sensitive for diagnosing TBM , it could be a indicate to diagnose TBM definitely , especially to distinguish the TBM and VM and a indicate . We had known that ADA is a mercapto enzyme , involved in the metabolism of adenosine . Some reports also showed that ADA was associated with the function of T cells tightly . So we can deduced that ADA may be a indicate which could reflect the cellular immune state of patients , which had seemed be related with the development and prognosis of TBM . ADA could also be a indicated to inspect the course of TBM ,furthermore it may also be used to instruct the clinical therapy.Although the level of ADA in CSF increased , we can`t use it as a golden indicate alone for there were still no definitely mechanism to interpret how was ADA involved in the development of TBM. Similarly, it was not sufficient to use PPD-IgG testing as a exclusive earlier diagnosis indicate of TBM yet , for existing 5% false positive in the test. Abov... |
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