脑脊液单核细胞内结核杆菌抗原检测对结核性脑膜炎的诊断价值

发布时间：2018-02-10 19:25

本文关键词： 结核性脑膜炎脑脊液单核细胞结核杆菌抗原纯化蛋白衍生物早期分泌抗原靶6　出处：《第四军医大学》2008年硕士论文　论文类型：学位论文

【摘要】： 由于多重耐药结核菌的流行、人类免疫缺陷病毒的感染及贫穷等多种因素的影响,结核病发病率呈日益回升的严重趋势,结核性脑膜炎(TBM)的发病率亦逐渐升高。TBM是严重的中枢神经系统感染性疾病,病死率和病残率均较高,而早期诊断、早期治疗是降低病死率、病残率的关键。目前尚无一种可靠实用的诊断方法能够满足临床诊断的需要。结核分支杆菌(MTB)是胞内寄生菌,侵入机体后主要寄生于宿主单核巨噬细胞内。机体感染MTB后体内首先出现的是结核抗原,而结核抗原的检出不受宿主免疫状态的影响。故本实验欲评价检测脑脊液(CSF)单核细胞内结核抗原对TBM诊断的价值,试图为TBM的诊断提供一种有效的方法。本实验以临床诊断为中枢神经系统感染的85例患者为研究对象,运用免疫细胞化学方法检测了其CSF和外周血(PB)单核细胞内结核菌素纯化蛋白衍生物(PPD)和早期分泌抗原靶6(ESAT-6),并应用流行病学实验和分析的方法,以受广泛认可的TBM临床诊断标准作为“金标准”,把研究对象分为TBM组(45例)和对照组(非MTB感染的中枢神经系统感染患者40例),评价了检测CSF和PB单核细胞内PPD及ESAT-6抗原诊断TBM的价值。实验结果:1.检测CSF单核细胞内PPD抗原,TBM组39例有阳性染色,对照组10例有阳性染色;检测ESAT-6抗原,TBM组39例有阳性染色,对照组6例有阳性染色。2.检测PB单核细胞内结核抗原,PPD和ESAT-6结果一致,TBM组11例有阳性染色,对照组无阳性染色。3.检测CSF单核细胞内PPD抗原和ESAT-6抗原诊断结脑的敏感度均为86.7%,特异度分别为87.5%和92.5%。4.检测PB单核细胞内PPD抗原和ESAT-6抗原诊断结脑的敏感度均为24.4%,特异度均为100%。5.TBM组CSF和PB的PPD、ESAT-6阳性细胞百分率均显著高于对照组(P0.001)。6.TBM组CSF的PPD、ESAT-6阳性细胞百分率均显著高于PB(P0.001)。结论:免疫细胞化学方法检测CSF单核细胞内结核抗原诊断TBM的灵敏度和特异度均较理想,且容易开展,可用于TBM的诊断,值得推广应用。而检测PB单核细胞内结核抗原诊断TBM的灵敏度较低,价值有限。
[Abstract]:Due to the prevalence of multidrug resistant tuberculosis, the infection of human immunodeficiency virus and poverty, the incidence of tuberculosis is increasing gradually. The incidence of tuberculous meningitis (TBM) also increased gradually. TBM is a serious infectious disease of the central nervous system. The mortality and disability rate of TBM are high, and the early diagnosis and treatment is to reduce the mortality. At present, there is no reliable and practical diagnostic method to meet the need of clinical diagnosis. Mycobacterium tuberculosis (MTB) is an intracellular parasite. After invading the body, it is mainly parasitic in the host mononuclear macrophages. After the body is infected with MTB, the first antigen that appears in the body is tuberculosis antigen. But the detection of tuberculosis antigen is not affected by the host immune state. Therefore, the purpose of this study is to evaluate the value of detecting monocyte tuberculosis antigen in cerebrospinal fluid (CSF) for the diagnosis of TBM, in order to provide an effective method for the diagnosis of TBM. In this study, 85 patients with central nervous system infection were studied. Immunocytochemistry was used to detect the purified protein derivative of tuberculin in monocytes of CSF and peripheral blood mononuclear cells (PPDs) and the early secretory antigen target 6ESAT-6. The methods of epidemiological experiment and analysis were used. Based on the widely accepted clinical diagnostic criteria of TBM, the study subjects were divided into two groups: TBM group (n = 45) and control group (n = 40). The detection of PPD in CSF and PB monocytes was evaluated. And the value of ESAT-6 antigen in the diagnosis of TBM. The positive staining was observed in 39 cases of CSF monocytes and 10 cases in control group, and 39 cases in ESAT-6 antigen group. Positive staining was found in 6 cases of control group. PPD and ESAT-6 showed positive staining in 11 cases of PB monocyte tuberculosis antigen. The sensitivity of detecting PPD antigen and ESAT-6 antigen in CSF monocytes was 86.7, and the specificity was 87.5% and 92.5.4.The sensitivity of detecting PPD antigen and ESAT-6 antigen in PB monocytes was 24. 4%. 5. The percentage of PPD-ESAT-6 positive cells in CSF and PB in TBM group was significantly higher than that in control group (P0.001). 6. The percentage of PPD-ESAT-6 positive cells in CSF group was significantly higher than that in P0.001TBM group. Conclusion: the sensitivity and specificity of immunocytochemistry for the detection of CSF monocyte tuberculosis antigen in the diagnosis of TBM are ideal and easy to develop. It can be used in the diagnosis of TBM. It is worth popularizing application, but the sensitivity of detecting PB monocyte tuberculosis antigen in TBM is low, and the value is limited.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R392

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