| Tuberculous meningitis (TBM) is the most serious type of a tuberculosis. InChina,tuberculosis diagnosis depends mainly on clinical manifestations, imagingexamination and sputum smear microscopy or bacterial culture or tuberculin skin test(PPD skin test). However,routine bacteriological examination method is poor ofsensitive, early diagnosis of TBM have no apparent clinical significance. Currentlyour country carried out a lot of research for the M. tuberculosis, but is still a lack ofqualitative research of important specific antigen.In this study, in order to find morespecific detection indicatiors to diagnose early TBM,we used the enzyme-linkedimmunosorbent assay (ELISA) quantitative analysis to analyse culture filtrate protein10(CFP-10) and Ag85.OBJETIVE: Detection the CFP-10,Ag85level in cerebrospinal fluid to explore thediagnostic value of both in early tuberculous meningitis.METHODS: We chose86patients of inpatient or outpatient treatment in Neurology,First Hospital of Jilin University in the period from March2010to September2011,and divided it into three groups.(1)TBM group：30cases of infection withMycobacterium tuberculosis,19males and11females; aged17to71years, average(42.33±12.58) years. All patients were admitted to hospital in early in the disease,The clinical manifestations were headache, fever, accompanied by nausea, vomiting,behavioral and psychological abnormalities, paralysis of limbs, and a stiff neck, thepositive pathologic,severe cases associated with disturbance of consciousness, herniaformation and other symptoms and signs. head CT or MRI of seven revealedhydrocephalus, chest CT examination of nine revealed tuberculosis. After3to4weeks of anti-TB drugs treatment,the condition of22in30patients significantlyimproved, two cases in critical condition to abandon treatment.(2)Intracranialinfection group:27patients of viral meningitis,11were male and6female; aged16to67years, average (26.35±14.67) years. As the first symptom of headache, fever, stiffneck, not accompanied by other signs of nervous system. Lumbar puncture and cerebrospinal fluid examinations showed only white blood cell count slightlyelevated, protein quantitation in the normal range or only mildly elevated. Imagingexamination had no abnormal findings.(3)Control group:29patients,13males and16females, aged19to61years, average (34.18±15.24) years. The main complaint isheadache, and the physical examination had no positive signs of the nervous system,cerebrospinal fluid and relevant examination of the indicators are in the normal range.RESULTS: The CFP-10level in CSF of patients in TBM group was examined by thenormality test.It was a skewed distuibution,the minimum detectable value is0.047,maximum2.586pg/mL, average0.743pg/mL. Instead of tuberculous meningitis,intracranial infection and control groups are normal distribution, the average level ofthe cerebrospinal fluid CFP-10were (0.024±0.013) pg/mL (0.020±0.013) pg/mL.The CFP-10level of cerebrospinal fluid in TBM group was higher than thecontrol group and non-tuberculous meningitis, intracranial infection. The differencewas statistically significant (t=11.245, P=0.000, t=11.245, t=12.614, P=0.000,);but no statistically significant differences between the control group andnon-tuberculous meningitis, intracranial infection(t=1.128, P=0.253).The Ag85level in TBM cerebrospinal fluid was skewed distribution,and the minimumdetectable value is0.747pg/mL, maximum27.841pg/mL, average1.096pg/mL.Non-tuberculous meningitis, intracranial infection group and the control groupshowed a normal distribution, Ag85average level is respectively(0.544±0.103) and(0.523±0.105) pg/mL]. The Ag85levels in cerebrospinal fluid of the TBM groupswas higher than the non-tuberculous meningitis, intracranial infection group and thecontrol group, the difference was statistically significant (t=10.769, P=0.000t=11.976, P=0.000),and no significant difference between non-tuberculous meningitis,intracranial infection group and the control group (t=0.980, P=0.329).CONCLUSION: The CFP-10and Ag85level in the cerebrospinal fluid can assist inearly diagnose of TBM. |
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