脑脊液LAM抗体检测对结核性脑膜炎的诊断价值

发布时间：2018-11-24 08:25

【摘要】：结核性脑膜炎（tuberculous meningitis，TBM）是由结核分枝杆菌（mycobacterium tuberculosis，Mtb）引起的脑膜非化脓性炎症性疾病，亦是中枢神经系统结核的最常见类型。目前在全球范围内，结核性脑膜炎的发病率呈上升趋势，死亡率约20-41%[9~11]。结核性脑膜炎的确诊十分困难，临床上易误诊为病毒性脑膜炎、新型隐球菌性脑膜炎等而延误治疗。随着免疫学的发展，目前已经发现了许多细胞因子在结核性脑膜炎疾病的发生发展中起着非常重要的作用[12,13]。结核杆菌抗体是在机体感染结核分枝杆菌后，于抗原的刺激下在组织局部合成的一种蛋白质。脂阿拉伯甘露聚糖（lipoarabinomannan，LAM）为结核分枝杆菌细胞壁脂多糖的主要结构，其作为结核分枝杆菌细胞壁的表面抗原，特异性强，并具有较强的免疫原性，在感染的宿主体内常会引起强烈的抗体反应，，能有效刺激机体产生IgG型LAM抗体。本文通过检测脑脊液LAM-IgG，评估其在早期诊断结核性脑膜炎的临床应用价值。目的探讨脑脊液中脂阿拉伯甘露聚糖抗体（LAM-IgG）检测对结核性脑膜炎的诊断价值。方法采用酶联免疫吸附试验（ELISA）分别检测TBM组（46例）、非TBM组（病毒性脑膜炎10例、化脓性脑膜炎12例）和正常对照组（22例）的脑脊液LAM-IgG表达水平。结果TBM组患者脑脊液LAM-IgG平均表达水平为0.11±0.027ng/ml，均明显高于非TBM组中的病毒性脑膜炎组（0.088±0.008ng/ml）、化脓性脑膜炎组（0.09±0.015ng/ml），及正常对照组（0.078±0.016ng/ml），差异具有统计学意义（P=0.006，P=0.007，P=0.000）。病毒性脑膜炎组、化脓性脑膜炎组及正常对照组三者间比较，差异无统计学意义（P=0.243，P=0.140，P=0.840）。结论检测脑脊液中LAM-IgG对结核性脑膜炎的早期诊断及鉴别诊断具有重要的临床价值。
[Abstract]:Tuberculous meningitis (tuberculous meningitis,TBM) is a non-suppurative inflammatory disease caused by Mycobacterium tuberculosis (mycobacterium tuberculosis,Mtb) and the most common type of tuberculosis in the central nervous system. Worldwide, the incidence of tuberculous meningitis is on the rise, with a mortality rate of 20-41% [9 / 11]. The diagnosis of tuberculous meningitis is very difficult, and is easily misdiagnosed as viral meningitis and Cryptococcus neoformans meningitis. With the development of immunology, many cytokines have been found to play an important role in the development of tuberculous meningitis. Mycobacterium tuberculosis antibody is a protein synthesized locally in tissue after infection with Mycobacterium tuberculosis and stimulated by antigen. Lipoarabannan (lipoarabinomannan,LAM) is the main structure of lipopolysaccharide in the cell wall of Mycobacterium tuberculosis. As the surface antigen of the cell wall of Mycobacterium tuberculosis, it has strong specificity and immunogenicity. A strong antibody response is often caused in the infected host, which can effectively stimulate the production of IgG type LAM antibodies. The clinical value of cerebrospinal fluid (CSF) LAM-IgG, in early diagnosis of tuberculous meningitis was evaluated. Objective to investigate the diagnostic value of LAM-IgG in cerebrospinal fluid (CSF) for tuberculous meningitis. Methods the expression of LAM-IgG in cerebrospinal fluid (CSF) of 46 cases of TBM group, 10 cases of viral meningitis, 12 cases of suppurative meningitis and 22 cases of normal control group were detected by Elisa (ELISA). Results the average expression of LAM-IgG in cerebrospinal fluid in TBM group was 0.11 卤0.027 ng / ml, which was significantly higher than that in viral meningitis group (0.088 卤0.008ng/ml) and suppurative meningitis group (0.09 卤0.015ng/ml). The difference was statistically significant between the control group and the control group (0.078 卤0.016ng/ml) (P 0. 006, P 0. 007, P 0. 000). There was no significant difference among viral meningitis group, suppurative meningitis group and normal control group (P < 0. 243). Conclusion Detection of LAM-IgG in cerebrospinal fluid has important clinical value in early diagnosis and differential diagnosis of tuberculous meningitis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R529.3

【参考文献】