脑脊液ESAT-6免疫细胞化学染色在结核性脑膜炎诊断中的价值

发布时间：2018-10-30 15:18

【摘要】：背景：早期、快速诊断结核性脑膜炎（tuberculous meningitis TBM）一直面临着巨大的挑战，根本的原因在于结核杆菌（Mycobacterium tuberculosis Mtb）属于胞内寄生菌，在单核细胞内寄生，现有的检测方法难以检测出脑脊液（cerebrospinal fluid CSF）中的结核杆菌。目前研究表明，结核杆菌早期分泌性特异性抗原靶6（early secretoryantigenic target6ESAT-6），存在于感染者的脑脊液免疫细胞中，我们的实验试图验证这种抗原在结核性脑膜炎实验室诊断中的效能。方法：203例疑诊结核性脑膜炎的连续病例入组，送检脑脊液常规、生化、细胞学、微生物培养，免疫细胞化学法染色脑脊液标本证明ESAT-6存在。结果：203例患者中，135例患者符合确诊结核性脑膜炎（TBM）标准：结核杆菌培养阳性33例，改良抗酸染色阳性135例。最后判定很可能结核性脑膜炎患者24例，可能结核性脑膜炎患者26例，非结核性脑膜炎患者18例。ESAT-6阳性细胞率在确诊结核性脑膜炎组、很可能结核性脑膜炎组、可能结核性脑膜炎组均明显高于非结核性脑膜炎组。灵敏度（Sensitivity Se）为98.5%（(95%CI98.4%to98.6%)），特异度（specificity Sp）为77.8%(75.9%to79.7%)，表明ESAT-6对协助TBM诊断有帮助。结论：脑脊液嗜中性粒细胞中存在ESAT-6阳性表达，脑脊液ESAT-6免疫细胞化学染色早期诊断TBM快速、敏感、特异性高。
[Abstract]:Background: early rapid diagnosis of tuberculous meningitis (tuberculous meningitis TBM) has been facing great challenges. The underlying reason is that Mycobacterium tuberculosis (Mycobacterium tuberculosis Mtb) is a parasitic bacterium in monocytes. It is difficult to detect Mycobacterium tuberculosis in cerebrospinal fluid (cerebrospinal fluid CSF) by existing detection methods. Current studies have shown that mycobacterium tuberculosis early secretory specific antigen target 6 (early secretoryantigenic target6ESAT-6) exists in the cerebrospinal fluid immune cells of infected patients. Our experiment attempts to verify the effectiveness of this antigen in laboratory diagnosis of tuberculous meningitis. Methods: 203 consecutive cases of suspected tuberculous meningitis were examined for routine cerebrospinal fluid (CSF) biochemistry cytology microbial culture and immunocytochemical staining to prove the existence of ESAT-6. Results: of the 203 cases, 135 cases met the (TBM) criteria for the diagnosis of tuberculous meningitis: 33 cases were positive for mycobacterium tuberculosis culture and 135 cases were positive for modified acid-fast staining. Finally, 24 cases of probable tuberculous meningitis, 26 cases of probable tuberculous meningitis and 18 cases of non-tuberculous meningitis were determined. The positive cell rate of ESAT-6 was found in the tuberculous meningitis group and the tuberculous meningitis group. Probably tuberculous meningitis group was significantly higher than non-tuberculous meningitis group. The sensitivity of (Sensitivity Se) was 98.5% (95CI98.4 to 98.6%) and the specificity of), was 77.8% (75.9% to 79.7%), indicating that ESAT-6 was helpful in the diagnosis of TBM. Conclusion: there is positive expression of ESAT-6 in neutrophils in cerebrospinal fluid (CSF). The early diagnosis of TBM by ESAT-6 immunocytochemical staining in cerebrospinal fluid (CSF) is rapid, sensitive and specific.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.3

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