| Background and ObjectiveTuberculosis is one of the infectious disease which severely threaten human health and the steadibility of society.With the apperance of anti-drug tuberculosis,the prevalence of AIDS and its coinfection with tuberculosis,tuberculosis has become one of the most threatening infectious disease all over the world.According to the statistics from WHO,1/3 of the world population are infected by mycobacterium tuberculosis(MTB),which increase by 900 million people every year and 300 million die of it.Tuberculous meningitis(TBM)is the most common infectious disease caused by MTB.Because TBM is a curable CNS infectious disease and ealy specified treatment is very effective,so ealy diagnosis and ealy treament that determined the prognosis.Lowenstein-Jensen cultivation method is the gold standard in detecting MTB,and also an important evidence in determining the diagnosis and chemical treament.It is also an reliable standard for evaluation of curative effect.But it costs more time(1-2 months),and the positive rate is only 20-30%,which are not suitable for clinical application.Althrough the regular smear and acid-fast stainning are rapid and cheap,but the positive rate is too low,and they can not tell the viable organism live or dead.Nucleic acid amplification is fast and accurate but it is more expensive and has a higher demand for lab requirements.Accordingly,It is necessary to explore a rapid and accurate method.last years,Phage amplified bologicalliy assay(PhaB) is a newly emerging method in detecting MTB quickly,which make it possible to rapid diagnosis and ealy treament of tuberculosis.We want to detect MTB and PhaB,and assisting with CSF cytology observation then analyse the correlated indexes.our study is to find a significant laboratory diagnosis method for ealy diagnosis of MTB.Materials and MethodsThe case group(TBM group) contains 86 cases,52 males and 34 females,aging from 15 to 82 years old,the mean age is 39.94±11.19;The control group 1(non-TBM group)contains 40 cases,13 males,27 females,aging from 12 to 68 years old,the mean age is 31.96±18.03;control group 2(normal group) contains 20 cases,11 males and 9 females,aging from 9 to 57 years old,the mean age is 26.44±12.22 years old.The patients were choosen from the out and in-patient department of respiratary and nerology department in the First Affiliated Hospital of Zhengzhou University in 2007-2008,all cases were diagnosed TMB according to the history,clinical and imaging manifestation,and lab examination.Lumbar Puncture was underook for all patients and the CSF regular test,biochemical,cytologcal test,Indian ink staining, acid-fast staining and MTB rapid cultivition were operated.ResultsIn TBM group,the number of patients whose white cell increased is up to 80 cases(93.0%);protein increased in 76 cases(8.4%);chloride increased in 50 cases (58.1%);glucose reduced have 52 cases(60.4%).In control group 1,the white cell population of 21 cases increased(52.5%);the protain increased have 15 cases(37.5%);chloride increased have 9 cases,glucose reduced have 8 cases(20%).In control group 2,the white cell population of 2 cases increased(10.0%),the rest indexes were normal.In TBM group,the elavation of white cell population and the reduction of glucose were mild.Biochemical test changed mainly on the dramatic elavation of protain and dramatic reduction ofchroide,CSF regular test and biochemical examination are the foundation of TBM diagnosis.For cyclogy examination,in TMB group 72 cases(83.7%)presented mixed cell reaction;in control group 1,8 cases (20%)presented mixed cell reaction.The cytology categorization were normal in the control group 2,TBM patients are more prone to mixed cell reaction.27 MTB cultivations were detected positive by nucleic acid amplification method,the positive rate is 31.4%,59 MTB cultivations were negative.5 MTB cultivations in control group 1 were positive,the positive rate is 12.5%,35 cases were negative(87.5%),all MTB cultivations in control group 2 were negetive,the result shows a significant difference(p＜0.05) comparing with the TBM group.Only 4 cases detected by smear and acid-fast stainning test were positive(4.65%),82 cases were negative(95.3%),compared with the "IBM group,a significant difference exists(p＜0.05).Phage amplified bologicalliy assay can observe the result within 18 to 24 hours and shorten the MTB cultivation time.Conclusions1.In "IBM group,the elavation of white cell population and the reduction of glucose were mild.Biochemical test changed mainly on the dramatic elavation of protain and dramatic reduction ofchroide.TBM patients are more prone to mixed cell reaction.2.CSF regular test,biochemical test and cytological dynamic observation have become important methods for TBM diagnosis now.3.Compared with traditional MTB cultivation and direct smear test,PhaB can detect the MTB conveniently and rapidly and the whole process needs only 18-24 hours.PhaB appears higher sensitivity so it specificity,and shows great application value for TBM diagnosis.4.CSF cytology assisting with PhaB rapid cultivation have a great practical value on the diagnosis,differential diagnosis and the turnover of the disease。... |
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