| Objectives:CD4~+Positive T-lymphocytes CD4~+T lymphocytes,interleukin-6(IL-6)and interleukin-8(interleukin-8)in peripheral blood were studied.Application value of IL-8 and cerebrospinal fluid immunoglobulin in diagnosis,efficacy and prognosis evaluation of Tubercular meningitis(TBM).Methods:This study was approved by the Ethics Committee of Kunming Third People’s Hospital,and all subjects signed informed consent.As a retrospective study,65 patients diagnosed or clinically diagnosed with TBM in Kunming Third People’s Hospital from January 2020 to December 2021 were included.In the first part,the changes of symptoms,signs,routine and biochemistry of cerebrospinal fluid,tuberculosis culture,tuberculosis gene detection,tuberculosis immunology detection and head magnetic resonance imaging in 65 patients with TBM were compared before treatment and 24W after treatment.In the second part,the cases of TBM patients were derived from the first part.At the same time,65 TB patients except the central nervous system were collected as the non-TBM group,and the serum CD4~+T cell count,IL-6 and IL-8 were compared between the two groups before treatment.The correlation between CD4~+T cell count,IL-6 and IL-8 and the positive rate of tuberculosis in cerebrospinal fluid was analyzed.To analyze whether CD4~+T cell count,IL-6 and IL-8 expression levels were risk factors for TBM prognosis.The TBM cases in the third part are derived from the first part.65 cases of Cryptococcal Meningitis(CM)meningitis patients are collected as the CM group,and the changes of cerebrospinal fluid Ig G,Ig M and Ig A before treatment between the two groups are compared.To analyze the correlation between cerebrospinal fluid Ig G,Ig M,Ig A and head MRI imaging,and the positive detection rate and prognosis of cerebrospinal fluid tuberculosis in TBM patients.Results:In the first part,fever,headache,nausea,vomiting,disturbance of consciousness,seizure,aphasia,multiple organ dysfunction or failure,Glass score and cerebral pressure were significantly improved in 65 TBM patients after 24W of treatment compared with those before treatment(P<0.05).There were no significant differences in paraplegia,hemiplegia,cranial nerve damage and cerebral hernia before and after treatment(P>0.05).Cerebrospinal fluid glucose,chloride and protein were significantly improved after TBM treatment(P<0.05).The cerebrospinal fluid(CSF)was positive before treatment but turned negative after treatment.In terms of head MRI,most lesions of patients with meningeal enhancement,nodules,granuloma,skull base adhesion and hydrocephalus before treatment were absorbed and improved after24W of treatment(P<0.05).There was no significant difference in cerebral infarction and cerebral edema before and after treatment(P>0.05).In the second part,TBM cases were from the first part,and 65 TB patients outside the central nervous system were in the non-TBM group.Before treatment,serum CD4~+T cell count in TBM group was significantly lower than that in non-TBM group(P<0.05).Serum IL-6 and IL-8 in TBM group before treatment were higher than those in non-TBM group(P<0.05).It is suggested that TBM and non-TBM tuberculosis have differences in the activation and expression of immune cells and cytokines.The serum CD4~+T cell count,IL-6 and IL-8 levels in TBM group were different after 24W treatment compared with before treatment(P<0.05),and CD4~+T cell count was at a low level before treatment and gradually recovered after treatment.IL-6 and IL-8,in contrast to CD4~+T cells,were significantly higher than normal before treatment and gradually decreased after treatment.The serum CD4~+T cell count in the TBM group was negatively correlated with the positive detection rate of cerebrospinal fluid tuberculosis(P<0.05),suggesting that the lower the serum CD4~+T cell count,the higher the positive detection rate of etiology.There was also a positive correlation between serum IL-6 and the positive detection rate of cerebrospinal fluid tuberculosis in the TBM group(P<0.05),indicating that the higher the serum IL-6value,the higher the positive detection rate.There was no correlation between serum IL-8 and the positive rate of cerebrospinal fluid tuberculosis(P>0.05)in the TBM group.Binary Logistic analysis showed that serum CD4~+T cells,IL-6 and IL-8 before treatment and prognosis after 24 weeks of treatment in TBM group.Serum CD4~+T cells and IL-8 were risk factors for prognosis and outcome of TBM,with P values(Sig.)<0.05,while IL-6 was not,with P values(Sig.)>0.05.In the third part,TBM cases were from the first part,and 65 CM patients were in the CM group.Before treatment,the level of CSF immunoglobulin in the TBM group was higher than that in the CM group,and the difference was statistically significant(P<0.05),suggesting that the level of CSF immunoglobulin in TBM was more significantly higher than that in CM.After 24 weeks of treatment,cerebrospinal fluid Ig G,Ig M and Ig A decreased significantly in TBM group,with statistical significance(P<0.05).The correlation analysis of cerebrospinal fluid(CSF)Ig G,Ig M,Ig A and the positive detection rate of tuberculosis originology in the TBM group showed that CSF Ig M,Ig A and the positive detection rate of etiology were correlated(P<0.05).There was no correlation between CSF Ig G and positive rate of etiology(P>0.05).The correlation analysis between cerebrospinal fluid immunoglobulin and prognosis in TBM group showed no correlation(P>0.05).In the TBM group,the correlation analysis between the brain MRI manifestations and the cerebrospinal fluid immunoglobulin showed that the cerebrospinal fluid Ig G and Ig M were correlated with the brain MRI manifestations(P<0.05),and were positively correlated.The higher the CSF Ig G and Ig M values were,the more likely the brain MRI manifestations were granuloma,nodules and enhancement,and the less likely the hydrocephalus was.There was no correlation between cerebrospinal fluid Ig A and head MRI of TBM(P>0.05).Conclusions:The detection of CD4~+T cell count in peripheral blood can evaluate the immune function of TBM patients,which can provide scientific basis for TBM immunotherapy,and has certain objective evaluation value in the evaluation of efficacy and prognosis.The detection of serum IL-6 and IL-8 in TBM patients can evaluate the degree of immune damage,and provide certain guiding value for glucocorticoid adjuvant therapy and immunomodulatory therapy in TBM patients.The detection of cerebrospinal fluid immunoglobulin in TBM patients has certain guiding significance for the diagnosis and differential diagnosis of TBM and other central nervous system infectious diseases,and the evaluation of the damage degree of blood-brain barrier.Therefore,this study suggests that peripheral blood CD4~+T cell count,IL-6,IL-8 and cerebrospinal fluid immunoglobulin have certain application value in the diagnosis,treatment guidance,therapeutic effect and prognosis evaluation of TBM. |
