發(fā)布時間：2018-05-08 08:24

  本文選題：結(jié)核性腦膜炎 + 腦脊液��； 參考：《河北醫(yī)科大學》2015年博士論文

【摘要】：背景:結(jié)核性腦膜炎(Tuberculous meningitis,TBM,簡稱結(jié)腦)是由結(jié)核分枝桿菌(Mycobacterium tuberculosis,MTB)感染引起的中樞神經(jīng)系統(tǒng)感染性疾病,約占結(jié)核病的10%左右。該病以腦實質(zhì)和腦膜受累最常見,并可波及至脊膜、脊髓的非化膿性炎癥性疾病。常繼發(fā)于粟粒性肺結(jié)核或體內(nèi)其它部位結(jié)核病,易感染兒童及合并人類免疫缺陷病毒感染的患者。在我國,結(jié)核病曾被稱為“白色瘟疫”、“十癆九死”的疾病,50年代以前,是危害人類健康的主要殺手,80年代被認為已經(jīng)被基本征服,但疾病“死亡地圖”研究顯示,90年代結(jié)核病又卷土重來,易感人群的數(shù)量不斷增加,因此,結(jié)核病又給全人類帶來了新的挑戰(zhàn),遏制結(jié)核病的發(fā)展已經(jīng)刻不容緩。結(jié)腦是肺外結(jié)核病中最嚴重的表現(xiàn)形式,由于其最初癥狀不典型,常常出現(xiàn)誤診或漏診而延誤了診斷及治療,加上目前耐藥結(jié)核病的大量出現(xiàn),致使很多結(jié)腦患者遺留了嚴重的后遺癥甚至是很高的死亡率,給整個家庭乃至國家都帶來巨大的負擔。多年來,國內(nèi)外學者一直致力于結(jié)腦診斷方面的研究,雖然大量的研究結(jié)果使我們對結(jié)腦有了更深的了解,但仍然有很多尚未解決的問題,因此,尋找早期、敏感、快速的診斷方法仍然是目前亟待解決的問題,同時也是防治結(jié)核病的迫切需要和降低結(jié)腦死亡率和致殘率的關(guān)鍵所在。2009年5月,國際結(jié)核病研究小組在南非確定了臨床診斷結(jié)腦的專家共識,為臨床早期診斷制定了簡單、容易操作的評價標準。專家共識中提到了腦脊液鏡檢查到抗酸桿菌、分離培養(yǎng)到結(jié)核分枝桿菌或者利用商業(yè)用自動PCR儀器檢測到結(jié)核分枝桿菌均可作為臨床確診結(jié)腦的“金標準”,為今后臨床診斷結(jié)腦提供了依據(jù)。第一部分 最新臨床評分標準在結(jié)核性腦膜炎診斷中的應用目的:本研究的目的是評價最新臨床評分標準在結(jié)腦診斷中的應用,為臨床提供簡單、可行的方法。方法:選取河北醫(yī)科大學第二醫(yī)院神經(jīng)內(nèi)科2012年1月-2013年10月門診及住院病人,剔除臨床資料不全者,共175例。其中臨床診斷結(jié)腦患者137例,對患者病歷資料進行回顧性分析并根據(jù)最新結(jié)腦臨床診斷標準進行評分,結(jié)腦組分為“確診組”、“很可能組”及“可能組”,共117例,每組均與改良抗酸染色結(jié)果進行對比后評價最新診斷標準的臨床應用價值。將確診組與對照組患者(病毒性腦炎38例)應用病例對照研究的方法,分析臨床表現(xiàn)、腦脊液檢查、影像學檢查及其他結(jié)核證據(jù)中各項指標與結(jié)腦確診的關(guān)系,并通過Logistic回歸分析對評分系統(tǒng)的各項指標進行多元分析,尋找影響結(jié)腦診斷的獨立影響因素。結(jié)果(1)結(jié)腦組分組情況結(jié)腦組共117例患者,其中確診組29例,很可能組28例,可能組60例。(2)各組間抗酸桿菌檢出率的比較確診組29例改良抗酸染色均為陽性,很可能組22例陽性,可能組56例陽性。結(jié)腦組抗酸桿菌總檢出率為91.5%。三組間抗酸桿菌檢出率比較差異有統(tǒng)計學意義(P0.05)。(3)單因素分析評分系統(tǒng)中影響結(jié)腦確診各因素的分析顯示,癥狀持續(xù)≥5天、顱神經(jīng)麻痹、腦脊液細胞數(shù)10-500個/ul、淋巴細胞50%、蛋白1g/L、糖2.2mmol/L或低于血糖的50%、存在結(jié)核瘤、腦梗死及CT/MRI/超聲提示存在顱外結(jié)核等在病例組與對照組間有統(tǒng)計學意義(P0.05),其他變量差異均無統(tǒng)計學意義(P0.05)。(4)多因素分析將可能影響結(jié)腦確診的9項因素作為自變量引入非條件逐步Logistic回歸模型進行多因素分析后,最終進入回歸方程具有統(tǒng)計學意義的自變量有癥狀持續(xù)≥5天、腦脊液細胞數(shù)10-500個/ul、蛋白1g/L及糖2.2mmol/L或低于血糖的50%。建立線性模型為:Y=-42.166+39.768(細胞數(shù)10-500個/ul)+20.251(蛋白1g/L)+19.858(糖2.2mmol/L或低于血糖的50%)+4.007(癥狀持續(xù)≥5天)。用回歸方程預測病例組的正確率為96.6%,對照組的正確率為97.4%,總正確率為97%。結(jié)論:最新臨床評分標準對結(jié)腦早期診斷有很好的預測性,腦脊液檢查對診斷有很大幫助,利用該評分系統(tǒng)可為早期診斷結(jié)腦提供可靠依據(jù)。第二部分 腦脊液參數(shù)對結(jié)核性腦膜炎早期診斷的預測意義目的:腦脊液參數(shù)可為結(jié)腦的診斷提供重要信息,本研究旨在對腦脊液常規(guī)、生化、細胞學等指標進行評估,分析這些指標對結(jié)腦早期診斷的預測價值。方法:對收集的100例患者的腦脊液資料進行回顧性分析,將腦脊液蛋白含量(1 g/l)、氯化物含量(120 mmol/l)、葡萄糖含量(2.2 mmol/l)、細胞數(shù)(10-500 cells/μl)、淋巴細胞增多(50%)及嗜中性粒細胞增多(50%)等數(shù)據(jù)進行分類整理后評價其對結(jié)腦診斷的應用價值。結(jié)果:腦脊液檢查各參數(shù)在結(jié)腦組與對照組差異均有統(tǒng)計學意義,腦脊液蛋白含量(1 g/l)、葡萄糖含量(2.2 mmol/l)、細胞數(shù)(10-500 cells/μl)及嗜中性粒細胞增多(50%)是影響結(jié)腦確診的獨立危險因素,對于預測結(jié)腦的敏感性分別為:66%、58%、86%、54%,特異性分別為:84%、98%、32%、98%。其中嗜中性粒細胞大于50%對于結(jié)腦的診斷具有很好的預測意義,結(jié)腦組中有84%的患者至少有2項陽性的腦脊液參數(shù),而對照組僅10%有2項及以上陽性的腦脊液參數(shù)。結(jié)論:腦脊液參數(shù)變化可為臨床早期診斷提供可靠依據(jù)。第三部分Ziehl-Neelsen染色熒光顯微鏡觀察在結(jié)核性腦膜炎診斷的應用目的:本研究的目的是提高傳統(tǒng)Ziehl-Neelsen抗酸染色的檢出率,探討一種早期確診結(jié)核性腦膜炎的有效、便捷方法。方法:所有病例組均來自河北醫(yī)科大學第二醫(yī)院神經(jīng)內(nèi)科2012年1月-2014年1月臨床診斷為結(jié)核性腦膜炎的住院及門診患者,采用專家共識的結(jié)腦臨床診斷標準對所有結(jié)腦患者進行評分。對照組為非結(jié)腦患者,對所有患者的腦脊液均行改良抗酸染色光鏡及熒光顯微鏡觀察并對結(jié)果進行分析。結(jié)果(1)一般情況病例組共99例(219份腦脊液),其中確診組27例(104份腦脊液),很可能組22例(39份腦脊液),可能組50例(76份腦脊液)。病例組中早期(1個月)患者共68例,中期(≥1個月)患者共31例。對照組患者共56例(56份腦脊液)(2)抗酸桿菌形態(tài)光鏡觀察藍色背景下抗酸桿菌被品紅染成紅色,有的細長略帶彎曲,第二部分腦脊液參數(shù)對結(jié)核性腦膜炎早期診斷的預測意義有的呈短桿狀,有的呈分叉狀或球狀,且能發(fā)現(xiàn)淋巴細胞、單核細胞及嗜中性粒細胞內(nèi)的抗酸桿菌;熒光顯微鏡下觀察黑色背景下所有細胞均不著色,僅僅抗酸桿菌被品紅著色后發(fā)出紅色熒光,形態(tài)與光鏡下基本一致,但較光鏡稍粗。(3)改良抗酸染色光鏡及熒光觀察的比較在52份經(jīng)證實含結(jié)核分枝桿菌的腦脊液中有44份在光鏡下發(fā)現(xiàn)抗酸桿菌,50份腦脊液在熒光顯微鏡下發(fā)現(xiàn)抗酸桿菌。改良抗酸染色熒光顯微鏡觀察的敏感性為96.2%,陽性預測值為89.3%。光鏡觀察的敏感性為84.6%,兩者比較差異有統(tǒng)計學意義(P0.05)。對照組共56份腦脊液,6份抗酸染色陽性,因此改良抗酸染色熒光顯微鏡觀察的特異性為89.3%,陰性預測值為96.2%。如果以所有樣本為研究對象,病例組光鏡檢出率為67.6%,熒光鏡檢的檢出率為78.5%,兩者比較差異有統(tǒng)計學意義(P0.05)。如果以病人為研究對象,病例組光鏡的檢出率為82.8%,熒光鏡檢的檢出率為90.9%,兩者比較差異有統(tǒng)計學意義(P0.05)。(4)改良抗酸染色熒光顯微鏡觀察檢出率與送檢時間的關(guān)系早期(即患者出現(xiàn)癥狀到就診時間1個月)光鏡鏡檢的檢出率為86.8%,熒光鏡檢的檢出率為95.6%,兩者比較差異有統(tǒng)計學意義(P0.05)。中期(即患者出現(xiàn)癥狀到就診時間≥1個月)光鏡鏡檢的檢出率為77.4%,熒光鏡檢的檢出率也是77.4%,兩者比較差異并沒有統(tǒng)計學意義。早期和中期改良抗酸染色熒光鏡檢的檢出率差異有統(tǒng)計學意義(P0.05)。結(jié)論:改良抗酸染色熒光顯微鏡觀察可作為早期診斷結(jié)腦的簡便、快速的檢測手段,臨床醫(yī)生應早期、多次送檢以提高檢出率。第四部分Gene Xpert MTB/RIF對結(jié)核性腦膜炎診斷的應用價值目的:本研究的目的是探討Xpert MTB/RIF檢測系統(tǒng)對結(jié)腦診斷的應用價值方法:所有病例組均來自河北醫(yī)科大學第二醫(yī)院神經(jīng)內(nèi)科2012年1月-2014年1月臨床診斷為結(jié)核性腦膜炎的住院及門診患者,共92例,對照組30例,對所有患者的腦脊液進行Xpert MTB/RIF檢測并記錄結(jié)果,將Xpert MTB/RIF結(jié)果分別與臨床診斷、傳統(tǒng)PCR檢測及改良抗酸染色進行比較,綜合評價其在結(jié)腦診斷中的應用價值。結(jié)果(1)傳統(tǒng)PCR、改良抗酸染色及Gene Xpert MTB/RIF檢測結(jié)果病例組92例患者中有82例抗酸染色陽性,11例Xpert MTB/RIF檢測結(jié)果為陽性,57例經(jīng)傳統(tǒng)PCR檢測后18例結(jié)果陽性,對照組30例Xpert MTB/RIF檢測均為陰性結(jié)果。(2)以臨床診斷作為結(jié)腦診斷的金標準,比較Gene Xpert MTB/RIF對結(jié)腦的診斷價值92例患者中11例陽性,陽性率為12.0%。其中確診組7例陽性,很可能組4例陽性,可能組均為陰性。確診組檢出率最高,其次為很可能組,本組資料中可能組無一例檢出。(3)以改良抗酸染色作為結(jié)腦診斷的金標準,比較Gene Xpert MTB/RIF對結(jié)腦的診斷價值。82例抗酸染色陽性的患者中有11例Gene Xpert MTB/RIF檢測陽性,陽性率為13.4%。(4)以傳統(tǒng)DNA檢測作為結(jié)腦診斷的金標準,比較Gene Xpert MTB/RIF對結(jié)腦的診斷價值18例DNA檢測陽性的患者中11例Gene Xpert MTB/RIF檢測陽性,陽性率為61.1%。(5)改良抗酸染色、傳統(tǒng)PCR檢測與Gene Xpert MTB/RIF檢測的比較92例患者均進行了改良抗酸染色與Gene Xpert MTB/RIF檢測,經(jīng)統(tǒng)計學比較提示兩種方法差異無統(tǒng)計學意義(P0.05);而同時經(jīng)傳統(tǒng)PCR檢測與Gene Xpert MTB/RIF檢測的患者共57例,比較后發(fā)現(xiàn)差異有統(tǒng)計學意義(P0.05),傳統(tǒng)PCR檢測陽性率較高。結(jié)論:Xpert MTB/RIF檢測系統(tǒng)可作為診斷結(jié)核性腦膜炎的金標準,但其陽性檢出率較低,應對腦脊液的處理過程進一步優(yōu)化,以提高其在結(jié)核性腦膜炎早期診斷中的應用價值。
[Abstract]:Background: Tuberculous meningitis (TBM) is an infectious disease of the central nervous system caused by Mycobacterium tuberculosis (MTB) infection, accounting for about 10% of tuberculosis. The disease is most common in the brain parenchyma and meninges, and can spread to the meninges and the non suppurative inflammatory diseases of the spinal cord. Disease. Often secondary to miliary tuberculosis or other parts of the body, it is easy to infect children and patients with human immunodeficiency virus infection. In our country, tuberculosis was once known as "white plague", "ten tuberculosis nine deaths", before 50s, is the main killer of human health, in 80s it was considered to have been basically conquered, But the disease "death map" research shows that in 90s, tuberculosis is coming back again and the number of susceptible people is increasing. Therefore, tuberculosis has brought new challenges to all human beings, and it is urgent to stop the development of tuberculosis. The misdiagnosis or missed diagnosis has delayed the diagnosis and treatment, as well as the large number of drug-resistant tuberculosis, resulting in serious sequelae and even high mortality in many patients. For years, scholars at home and abroad have been devoted to the research of brain diagnosis, although a large amount of research has been made. We have a deeper understanding of the brain, but there are still a lot of unsolved problems. Therefore, the search for early, sensitive and rapid diagnostic methods remains an urgent problem at the moment, and is also the key to the urgent need to prevent tuberculosis and to reduce the rate of death and disability of the brain in May, international tuberculosis (.2009). The disease research team established an expert consensus on the clinical diagnosis of brain nodules in South Africa to establish simple, easy to operate evaluation criteria for early clinical diagnosis. The expert consensus referred to cerebrospinal fluid endoscopy for acid resistant bacilli, isolation and culture to Mycobacterium tuberculosis, or detection of Mycobacterium tuberculosis by commercial auto PCR instruments. The "gold standard" for clinical diagnosis of the brain provides a basis for the future clinical diagnosis of the brain. The purpose of the first part of the latest clinical scoring standard in the diagnosis of tuberculous meningitis: the purpose of this study is to evaluate the application of the latest clinical scoring standard in the diagnosis of the brain, and to provide a simple and feasible method for the treatment of the bed. Method: select Hebei The neurology department of the second hospital of Medical University in January 2012 -2013 October outpatient and hospitalized patients, excluding patients with incomplete clinical data, 175 cases, of which 137 cases of clinical diagnosis of brain patients, a retrospective analysis of the patient's medical records and according to the latest clinical diagnostic criteria, the brain group is divided into "confirmed group", "very likely group" "And" possible group ", a total of 117 cases, each group was compared with the improved acid staining results to evaluate the clinical value of the latest diagnostic criteria. The diagnosis group and the control group (38 cases of viral encephalitis) were used in a case-control study to analyze the clinical manifestations, cerebrospinal fluid examination, imaging examination and other tuberculosis evidence. The relationship between the standard and the diagnosis of the nodal brain, and the multiple analysis of the indexes of the scoring system by Logistic regression analysis to find the independent factors affecting the diagnosis of the nodal brain. Results (1) there were 117 patients in the group of brain groups, including 29 cases, 28 cases and 60 cases. (2) the detection rate of acid bacilli in each group. The improved anti acid staining was positive in 29 cases, 22 cases were positive and 56 cases were positive. The total detection rate of acid bacilli in the group of 91.5%. three groups was statistically significant (P0.05). (3) the analysis of various factors in the single factor analysis scoring system showed that the symptoms continued to be more than 5. Days, cranial nerve paralysis, the number of cerebrospinal fluid cells in 10-500 /ul, lymphocyte 50%, protein 1g/L, sugar 2.2mmol/L or lower than 50% of blood sugar, there were tuberculoma, cerebral infarction and CT/MRI/ ultrasound showed that there was statistical significance between the case group and the control group (P0.05), and the difference of other variables was not statistically significant (4) multivariate analysis. The 9 factors that may affect the diagnosis of the brain as independent variables are introduced into the non conditional stepwise Logistic regression model for multiple factors analysis. After the regression equation has statistical significance, the symptom continues to be more than 5 days, the number of cerebrospinal fluid cells is 10-500 /ul, the protein 1g/L and sugar 2.2mmol/L or lower blood glucose 50%. establish a linear model. Y=-42.166+39.768 (cell number 10-500 /ul) +20.251 (protein 1g/L) +19.858 (sugar 2.2mmol/L or lower than 50% of blood sugar) +4.007 (symptoms lasting more than 5 days). The correct rate of the case group was predicted by the regression equation 96.6%, the correct rate in the control group was 97.4%, the total correct rate was 97%. conclusion: the latest clinical scoring standard has a good preview of the early diagnosis of the brain. The evaluation of cerebrospinal fluid (CSF) has great help for diagnosis. Using this scoring system can provide a reliable basis for early diagnosis of the brain. Second the predictive significance of the parameters of cerebrospinal fluid to the early diagnosis of tuberculous meningitis: the parameters of cerebrospinal fluid can provide important information for the diagnosis of the brain, and this study aims at the routine, biochemical and cytological study of cerebrospinal fluid. Evaluation and analysis of these indexes to predict the early diagnosis of the brain. Methods: the cerebrospinal fluid data of 100 patients collected were analyzed retrospectively, the content of cerebrospinal fluid protein (1 g/l), chloride content (120 mmol/l), glucose content (2.2 mmol/l), cell number (10-500 cells/ Mu L), lymphocyte increase (50%) and neutrophils The application value of granulocytosis (50%) and other data was evaluated. Results: the differences in the cerebrospinal fluid examination parameters in the brain group and the control group were statistically significant, the content of cerebrospinal fluid protein (1 g/l), glucose content (2.2 mmol/l), the number of fine cell (10-500 cells/ Mu L) and neutrophils (50%) were affected. The independent risk factors for brain diagnosis were 66%, 58%, 86%, 54%, respectively: 84%, 98%, 32%. 98%. neutrophils greater than 50% had a good predictive value for the diagnosis of the brain, 84% of the patients in the brain group had at least 2 positive cerebrospinal parameters, while only 10% in the control group were 2. Conclusions: the changes in cerebrospinal fluid parameters can provide a reliable basis for early clinical diagnosis. Third Ziehl-Neelsen staining fluorescence microscopy is used to observe the application of the diagnosis of tuberculous meningitis. The purpose of this study is to improve the detection rate of traditional Ziehl-Neelsen anti acid staining and to explore an early diagnosis. Effective and convenient methods of nuclear meningitis. Methods: all cases were from the neurology department of the second hospital of Hebei Medical University in January -2014 January 2012, which were clinically diagnosed as tuberculosis meningitis inpatients and outpatients. All the patients were scored by the expert consensus nodal clinical diagnostic criteria. The control group was a non nodule patient, All patients' cerebrospinal fluid was observed with modified acid staining light microscopy and fluorescence microscopy. Results (1) the general case group was 99 cases (219 cerebrospinal fluid), of which 27 cases (104 cerebrospinal fluid), 22 cases (39 cerebrospinal fluid) and 50 cases (76 cerebrospinal fluid), and the early (1 months) patients in the case group. A total of 68 cases, intermediate (> 1 months) patients with 31 cases, 56 cases (56 cerebrospinal fluid) (56 cerebrospinal fluid) (2) acid bacilli (2) observed the acid bacilli morphological light microscope, the acid bacillus was dyed red under the blue background, some elongated and slightly curved, and the second part of the cerebrospinal fluid parameters had a short pole shape in the prediction of the early diagnosis of tuberculous meningitis, and some were bifurcated. All cells in the black background were not coloured under fluorescent microscope. Only acid resistant bacilli were stained with red color after coloring of fuchsin. The morphology was basically consistent with light microscope, but slightly thicker than light microscope. (3) improved acid staining light microscopy and fluorescence view. 44 of the 52 confirmed cerebrospinal fluid containing Mycobacterium tuberculosis found anti acid bacilli under light microscope, 50 cerebrospinal fluid found acid bacillus under fluorescence microscope. The sensitivity of improved anti acid staining fluorescence microscopy was 96.2%, and the sensitivity of positive predictive value of 89.3%. optical microscopy was 84.6%. Study significance (P0.05). The control group had 56 cerebrospinal fluid and 6 acid positive staining. Therefore, the specificity of the improved acid staining fluorescence microscope was 89.3%, and the negative predictive value was 96.2%. if all the samples were studied, the detection rate of light microscopy in the case group was 67.6% and the fluoroscopy detection rate was 78.5%, and the difference was statistically significant. (P0.05) if the patient was taken as the study object, the detection rate of light microscopy in the case group was 82.8% and the detection rate of fluoroscopy was 90.9%, and the difference was statistically significant (P0.05). (4) the detection of the relationship between the detection rate of the improved acid staining fluorescence microscope and the time of delivery (that is, the symptoms to the time of treatment for 1 months) was detected by light microscopy. The rate of detection was 86.8%, the detection rate of fluoroscopy was 95.6%, and the difference was statistically significant (P0.05). The detection rate of light microscopy was 77.4% in the middle period (that is, the symptoms of patients were more than 1 months), and the detection rate of fluoroscopy was 77.4%. There was no statistical difference between the two. The difference in detection rate was statistically significant (P0.05). Conclusion: modified acid staining fluorescence microscopy can be used as a simple and rapid detection method for early diagnosis of brain. The clinical value of fourth parts of Gene Xpert MTB/RIF for the diagnosis of nuclear meningitis is to be used by clinicians to improve the detection rate. To explore the application value of Xpert MTB/RIF detection system to brain diagnosis: all case groups were from the neurology department of the second hospital of Hebei Medical University in January January 2012 -2014 in the clinical diagnosis of tuberculosis meningitis inpatients and outpatients, a total of 92 cases, 30 cases of the control group, Xpert MTB/RIF detection of all the patients' cerebrospinal fluid. The results were recorded, and Xpert MTB/RIF results were compared with clinical diagnosis, traditional PCR detection and modified acid staining, and their application value in brain diagnosis was evaluated synthetically. Results (1) there were 82 cases of acid staining positive in 92 patients with traditional PCR, improved acid staining and Gene Xpert MTB/RIF detection results, and 11 cases of Xpert MTB/RIF test. The test results were positive in 57 cases, 18 cases were positive after the traditional PCR test, and 30 cases of Xpert MTB/RIF in the control group were negative results. (2) the clinical diagnosis was used as the gold standard for the diagnosis of the brain, and the diagnostic value of Gene Xpert MTB/RIF on the nodal brain was positive in 92 cases, and the positive rate of the positive rate was 12.0%. in 7 cases, and the possibility group was 4 cases. The positive rate of the group was negative. The positive rate of the confirmed group was the highest, the next was the possible group, and there was no case in the group. (3) to improve the anti acid staining as the gold standard for the diagnosis of the brain, compare the diagnostic value of Gene Xpert MTB/RIF to the nodal brain, and 11 cases of Gene Xpert MTB/RIF detection positive in the patients with positive acid staining with acid staining. The sex rate was 13.4%. (4) with the traditional DNA detection as the gold standard for the diagnosis of the brain, and compared the diagnostic value of Gene Xpert MTB/RIF to the nodal brain. 11 cases of Gene Xpert MTB/RIF detection in 18 cases of DNA positive were positive, the positive rate was 61.1%. (5) modified acid staining, and the comparison between the traditional PCR and Gene 92 cases was carried out. The improved acid staining and Gene Xpert MTB/RIF detection showed that there was no statistical difference between the two methods (P0.05), while 57 cases were detected by traditional PCR and Gene Xpert MTB/RIF, and the difference was statistically significant (P0.05) and the positive rate of traditional PCR was higher. Conclusion: Xpert MTB/RIF detection system can be found. As a gold standard for the diagnosis of tuberculous meningitis, its positive detection rate is relatively low, and the treatment process of cerebrospinal fluid should be further optimized to improve it.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R529.3

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