Diagnostic Value Of Cerebrospinal Fluid Adenosine Deaminase And Serum 5'-Nucleotidase In Tuberculous Meningitis

Objectives: To evaluate the diagnostic role of different ways for tuberculous meningitis(TBM).Mainly to discuss the value of cerebrospinal fluid adenosine deaminase(CSF-ADA)and serum 5'-nucleotidase(5'-NT)in the diagnosis and differential diagnosis of tuberculous meningitis.Methods: Patient characteristics,results of CSF examination,hematology examination and imaging findings of 40 patients with tuberculous meningitis and 36 patients with viral meningitis(VM)hospitalized in the First Affiliated Hospital of Xinjiang Medical University in June 2014 and December2018 were recorded and analyzed retrospectively.Results: There was no significant difference in gender and age between TBM group and VM group(P>0.05).The results of CSF examination,hematology examination and imaging findings of CSF in TBM group were different from those in VM group(P<0.05).CSF-ADA>4.40U/L or serum5'-NT>4.85U/L was considered to be positive according to their receiver operating characteristic curve(ROC),sensitivity of CSF-ADA was 92.5%,specificity was 89%,the area under the curve(AUC)was 0.957,95% Confidence interval(CI)was(0.916-0.997).Sensitivity of serum 5'-NT was 95%,specificity was 70%,AUC was 0.840,95%CI was(0.750-0.931).When combined CSF-ADA and serum 5'-NT to diagnose tuberculous meningitis(either CSF-ADA>4.40U/L or serum 5'-NT>4.85U/L),sensitivity was 97.5%,specificity was 73.5%,positive likelihood ratio(PLR)was 3.68,negative likelihood ratio(NLR)was 0.03.Conclusion: In the diagnosis of tuberculous meningitis,CSF-ADA and serum 5'-NT can play a rapid,simple and relatively accurate diagnostic role.Early diagnosis of tuberculous meningitis could be made when either CSF-ADA or serum5'-NT is positive,and considering the patient's clinical magnifications,radiograph and lab data at the same time.