脑脊液与血浆生化指标比值对结核性脑膜炎与化脓性脑膜炎的鉴别意义

摘要

目的：探讨脑脊液（CSF）与血浆生化指标比值对结核性脑膜炎与化脓性脑膜炎的鉴别意义。方法选取2007年1月—2013年12月湖州市中心医院神经内科及感染科收治的结核性脑膜炎患者55例（结核性脑膜炎组），化脓性脑膜炎患者73例（化脓性脑膜炎组）。采集患者静脉血及 CSF 标本，测定其 CSF 及血浆糖、蛋白、腺苷脱氨酶（ADA）和氯化物含量，并计算 CSF/血浆中上述生化指标的比值。结果两组 CSF 糖、蛋白含量比较，差异无统计学意义（P ＞0.05）；结核性脑膜炎组氯化物含量低于化脓性脑膜炎组，ADA 含量高于化脓性脑膜炎组（P ＜0.05）。两组血浆糖含量比较，差异无统计学意义（P ＞0.05）；结核性脑膜炎组蛋白、氯化物含量低于化脓性脑膜炎组，ADA 含量高于化脓性脑膜炎组（P ＜0.05）。两组 CSF/血浆糖比值比较，差异无统计学意义（P ＞0.05）；结核性脑膜炎组蛋白比值、ADA 比值高于化脓性脑膜炎组，氯化物比值低于化脓性脑膜炎组（P ＜0.05）。绘制 CSF/血浆 ADA 比值联合氯化物比值诊断结核性脑膜炎的 ROC 曲线，选取切点 ADA 比值≥1.19且氯化物比值≤0.93时，灵敏度为78.2％，特异度为78.1％，曲线下面积为0.836。结论 CSF 中 ADA、氯化物含量和 CSF/血浆蛋白、ADA、氯化物比值在结核性脑膜炎中有特定意义，特别是 CSF/血浆 ADA 比值≥1.19联合氯化物比值≤0.93时对结核性脑膜炎的诊断意义较大，有助于临床医生鉴别结核性脑膜炎和化脓性脑膜炎。%Objective To explore the value of the ratios of cerebrospinal fluid(CSF)to plasma biochemical indices in identifying tuberculous meningitis( TBM) and purulent meningitis( PM). Methods We enrolled 55 patients with TBM (TBM group)and 73 patients with PM(PM group)from the Department of Neurology of Huzhou Central Hospital from January 2007 to December 2013. Venous blood and CSF samples were collected. The glucose,protein,ADA and chloride content in CSF and plasma were examined. And the ratios of CSF to plasma biochemical indices were calculated. Results The two groups were not significantly different(P > 0. 05)in the glucose and protein content in CSF;the TBM group was lower(P < 0. 05)in CSF chloride content and was higher(P < 0. 05) in CSF ADA content than PM group. The two groups were not significantly different(P > 0. 05)in the glucose content in plasma;the TBM group was lower(P < 0. 05) in plasma chloride and protein content and was higher(P < 0. 05)in plasma ADA content than PM group. The two groups were not significantly different(P >0. 05)in the CSF/ plasma glucose content ratio;the TBM group was higher(P < 0. 05)in the protein and ADA ratio and lower (P < 0. 05)in chloride ratio than PM group. In the ROC curve for diagnosing TBM combining ADA and chloride ratio and at the point of tangency with CSF/ plasma ADA ratio ≥1. 19 and CSF/ plasma chloride ratio ≤0. 93,the sensitivity degree was 78. 2% , the specificity degree was 78. 1% and the area under curve was 0. 836. Conclusion The content of ADA and chloride in CSF and CSF/ plasma protein,ADA and chloride ratios are of particular significance in TBM. Especially when ADA ratio ≥1. 19 and chloride ratio ≤0. 93,the indices are of great importance in diagnosing TBM accurately and distinguishing TBM from PM.