【摘要】：背景：早期、快速診斷結(jié)核性腦膜炎（tuberculous meningitis TBM）一直面臨著巨大的挑戰(zhàn)，根本的原因在于結(jié)核桿菌（Mycobacterium tuberculosis Mtb）屬于胞內(nèi)寄生菌，在單核細胞內(nèi)寄生，現(xiàn)有的檢測方法難以檢測出腦脊液（cerebrospinal fluid CSF）中的結(jié)核桿菌。目前研究表明，結(jié)核桿菌早期分泌性特異性抗原靶6（early secretoryantigenic target6ESAT-6），存在于感染者的腦脊液免疫細胞中，我們的實驗試圖驗證這種抗原在結(jié)核性腦膜炎實驗室診斷中的效能。 方法：203例疑診結(jié)核性腦膜炎的連續(xù)病例入組，送檢腦脊液常規(guī)、生化、細胞學、微生物培養(yǎng)，免疫細胞化學法染色腦脊液標本證明ESAT-6存在。 結(jié)果：203例患者中，135例患者符合確診結(jié)核性腦膜炎（TBM）標準：結(jié)核桿菌培養(yǎng)陽性33例，改良抗酸染色陽性135例。最后判定很可能結(jié)核性腦膜炎患者24例，可能結(jié)核性腦膜炎患者26例，非結(jié)核性腦膜炎患者18例。ESAT-6陽性細胞率在確診結(jié)核性腦膜炎組、很可能結(jié)核性腦膜炎組、可能結(jié)核性腦膜炎組均明顯高于非結(jié)核性腦膜炎組。靈敏度（Sensitivity Se）為98.5%（(95%CI98.4%to98.6%)），特異度（specificity Sp）為77.8%(75.9%to79.7%)，表明ESAT-6對協(xié)助TBM診斷有幫助。 結(jié)論：腦脊液嗜中性粒細胞中存在ESAT-6陽性表達，腦脊液ESAT-6免疫細胞化學染色早期診斷TBM快速、敏感、特異性高。
[Abstract]:Background: early rapid diagnosis of tuberculous meningitis (tuberculous meningitis TBM) has been facing great challenges. The underlying reason is that Mycobacterium tuberculosis (Mycobacterium tuberculosis Mtb) is a parasitic bacterium in monocytes. It is difficult to detect Mycobacterium tuberculosis in cerebrospinal fluid (cerebrospinal fluid CSF) by existing detection methods. Current studies have shown that mycobacterium tuberculosis early secretory specific antigen target 6 (early secretoryantigenic target6ESAT-6) exists in the cerebrospinal fluid immune cells of infected patients. Our experiment attempts to verify the effectiveness of this antigen in laboratory diagnosis of tuberculous meningitis. Methods: 203 consecutive cases of suspected tuberculous meningitis were examined for routine cerebrospinal fluid (CSF) biochemistry cytology microbial culture and immunocytochemical staining to prove the existence of ESAT-6. Results: of the 203 cases, 135 cases met the (TBM) criteria for the diagnosis of tuberculous meningitis: 33 cases were positive for mycobacterium tuberculosis culture and 135 cases were positive for modified acid-fast staining. Finally, 24 cases of probable tuberculous meningitis, 26 cases of probable tuberculous meningitis and 18 cases of non-tuberculous meningitis were determined. The positive cell rate of ESAT-6 was found in the tuberculous meningitis group and the tuberculous meningitis group. Probably tuberculous meningitis group was significantly higher than non-tuberculous meningitis group. The sensitivity of (Sensitivity Se) was 98.5% (95CI98.4 to 98.6%) and the specificity of), was 77.8% (75.9% to 79.7%), indicating that ESAT-6 was helpful in the diagnosis of TBM. Conclusion: there is positive expression of ESAT-6 in neutrophils in cerebrospinal fluid (CSF). The early diagnosis of TBM by ESAT-6 immunocytochemical staining in cerebrospinal fluid (CSF) is rapid, sensitive and specific.
【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R529.3

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