本文選題：結(jié)核性腦膜炎 + CFP-10��； 參考：《吉林大學(xué)》2013年碩士論文

【摘要】：結(jié)核性腦膜炎（TBM）為結(jié)核病中最為嚴(yán)重的一種類型，目前我國有關(guān)結(jié)核病的診斷主要依據(jù)臨床表現(xiàn)、影像學(xué)檢查并結(jié)合痰涂片鏡檢或細(xì)菌培養(yǎng)或結(jié)核菌素皮膚試驗(yàn)（PPD皮試）。然而，由于常規(guī)細(xì)菌學(xué)檢查方法靈敏性較差，對(duì)TBM的早期診斷不具明顯臨床意義。目前國內(nèi)針對(duì)結(jié)核桿菌的研究較多，但尚缺乏對(duì)重要特異性抗原的定性研究，本研究中，我們應(yīng)用酶聯(lián)免疫吸附試驗(yàn)（ELISA）定量分析培養(yǎng)濾液蛋白10（CFP-10）和Ag85，以尋求對(duì)早期TBM診斷更具特異性的檢測指標(biāo)。 目的通過檢測腦脊液中CFP-10、Ag85的水平來探討二者對(duì)早期結(jié)核性腦膜炎的臨床診斷價(jià)值。 方法選擇2010年3月-2011年9月在吉林大學(xué)白求恩第一醫(yī)院神經(jīng)內(nèi)科住院或門診就診的86例患者。（1）TBM組：結(jié)核分枝桿菌感染30例，男性19例，女性11例；年齡17～71歲，平均（42.33±12.58）歲。所有患者均于發(fā)病早期入院，臨床表現(xiàn)為頭痛、發(fā)熱，伴惡心、嘔吐、精神行為異常、肢體癱瘓，以及頸項(xiàng)強(qiáng)直、病理征陽性，嚴(yán)重者伴意識(shí)障礙、腦疝形成等癥狀與體征。其中7例頭部CT或MRI檢查顯示腦積水，9例胸部CT檢查發(fā)現(xiàn)肺結(jié)核。30例患者中22例經(jīng)3～4周抗結(jié)核藥物治療后病情明顯好轉(zhuǎn)，2例病情危重者放棄治療。（2）非TBM顱內(nèi)感染組：病毒性腦膜炎患者27例，男性11例，女性6例；年齡16～67歲,平均（26.35±14.67）歲。以頭痛、發(fā)熱為首發(fā)癥狀，查體有頸項(xiàng)強(qiáng)直，不伴有其他神經(jīng)系統(tǒng)體征；腰椎穿刺腦脊液檢查僅白細(xì)胞計(jì)數(shù)輕度升高，蛋白定量于正常值范圍或僅輕度升高；影像學(xué)檢查無異常發(fā)現(xiàn)。（3）對(duì)照組：29例患者，男性13例，女性16例，年齡19～61歲，平均（34.18±15.24）歲。就診時(shí)以頭痛為主訴，體格檢查未發(fā)現(xiàn)神經(jīng)系統(tǒng)陽性體征，腦脊液及相關(guān)檢查各項(xiàng)指標(biāo)均于正常值范圍。 結(jié)果TBM組患者腦脊液CFP-10水平經(jīng)正態(tài)性檢驗(yàn)，呈偏態(tài)分布，最小檢測值為0.047、最大值為2.586pg/mL，平均水平0.743pg/mL；而非TBM顱內(nèi)感染組和對(duì)照組均為正態(tài)分布，其腦脊液CFP-10平均水平分別為（0.024±0.013）pg/mL和（0.020±0.013）pg/mL。TBM組患者腦脊液CFP-10水平高于非TBM顱內(nèi)感染組和對(duì)照組，且差異具有統(tǒng)計(jì)學(xué)意義（t=11.245，，P＝0.000，t=11.245，t=12.614，P＝0.000）；但非TBM顱內(nèi)感染組與對(duì)照組之間差異無統(tǒng)計(jì)學(xué)意（t=1.128，P=0.253）。 TBM組患者腦脊液Ag85水平呈偏態(tài)分布，最小檢測值為0.747pg/mL、最大檢測值為27.841pg/mL，平均測值為1.096pg/mL非TBM顱內(nèi)感染組和對(duì)照組呈正態(tài)分布，Ag85平均水平分別為（0.544±0.103）和（0.523±0.105）pg/mL]。TBM組腦脊液Ag85水平高于非TBM顱內(nèi)感染組和對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（t=10.769，P＝0.000t=11.976，P＝0.000）；而非TBM顱內(nèi)感染組與對(duì)照組之間差異無統(tǒng)計(jì)學(xué)意義（t=0.980，P=0.329）。 結(jié)論檢測腦脊液中CFP-10、Ag85的水平可以輔助TBM的早期診斷
[Abstract]:TB meningitis ( TBM ) is one of the most serious types of tuberculosis . At present , the diagnosis of tuberculosis in China is mainly based on clinical manifestation , imaging examination and combined with sputum smear microscopy or bacterial culture or tuberculin skin test ( PPD skin test ) . However , due to the poor sensitivity of routine bacteriological examination method , there is no significant clinical significance for the early diagnosis of TBM . In the present study , we used enzyme linked immunosorbent assay ( ELISA ) to quantitatively analyze the filtrate protein 10 ( cfp - 10 ) and Ag85 , so as to find more specific detection index for early TBM diagnosis .

Objective To evaluate the clinical diagnostic value of the two methods for early tuberculous meningitis by detecting the level of the concentration of CFp - 10 and Ag85 in cerebrospinal fluid .

Methods From March 2010 to September 2011 , 86 patients were admitted to the First Affiliated Hospital of Bethune First Affiliated Hospital of Jilin University . ( 1 ) TBM group : 30 cases of Mycobacterium tuberculosis infection , 19 males and 11 females ;
All patients were admitted to the hospital at the age of 17 - 71 years , average ( 42.33 鹵 12.58 ) years old . All patients were admitted to the hospital in the early stage . The clinical manifestations were headache , fever , nausea , vomiting , abnormal mental behavior , limb paralysis , and cerebral hernia formation . Among them , 22 of the 30 patients were treated with anti - tuberculosis drugs for 3 锝

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