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目的探讨不同实验室检查方法对小儿结核性脑膜炎(TBM)的诊断价值,为其早期诊断寻求方法。方法收集2009年3月至2011年2月新乡医学院第一附属医院结核内科和小儿内科的TBM住院患儿30例,另将同期在该院小儿内科诊断为非结核菌感染的脑炎、脑膜炎或其他脑部病变的30例住院患儿设为对照组。对两组患儿运用荧光定量PCR(FQ-PCR)技术检测脑脊液(CSF)中结核DNA、结核抗体、抗酸杆菌涂片、结核菌培养、腺苷脱氨酶(ADA)活性5种方法进行检测,并将结果进行比较分析。结果 FQ-PCR阳性率与抗酸杆菌涂片、结核菌培养、结核抗体检测差异均有统计学意义(P<0.05);30例TBM患者ADA值升高14例,对照组有6例升高,敏感性与FQ-PCR差异无统计学意义,但特异性(80%)低于FQ-PCR(100%),差异有统计学意义。涂片法和培养法对脑脊液检出率差异无统计学意义。FQ-PCR和ADA两种方法的TBM组和对照组之间差异均有统计学意义。结论 FQ-PCR检测脑脊液结核DNA,简便、快速、敏感性高、特异性强,有助于早期诊断。
Objective To investigate the diagnostic value of different laboratory tests in pediatric patients with tuberculous meningitis (TBM), and to find a method for its early diagnosis. Methods Thirty patients with TBM admitted to the First Affiliated Hospital of Xinxiang Medical College from March 2009 to February 2011 were enrolled in this study. The etiology of non-TB infection, encephalitis, Thirty cases of hospitalized infants with inflammation or other brain lesions were assigned as control group. Five methods of detecting tuberculosis DNA, tuberculosis antibody, acid-fast bacilli smear, tubercle bacilli culture and adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) were detected by FQ-PCR in two groups of children Test, and compare the results. Results The positive rate of FQ-PCR was significantly different from that of acid-fast bacilli smear, tubercle bacilli culture and tuberculosis antibody test (P <0.05). In 30 TBM patients, the ADA value was increased in 14 cases and in control group, 6 cases were elevated There was no significant difference between sensitivity and FQ-PCR, but the specificity (80%) was lower than FQ-PCR (100%), the difference was statistically significant. There was no significant difference in detection rate of cerebrospinal fluid between smear method and culture method. FQ-PCR and ADA two methods of TBM group and control group differences were statistically significant. Conclusion FQ-PCR detection of cerebrospinal fluid DNA, simple, rapid, high sensitivity, specificity, contribute to the early diagnosis.