【摘要】：結(jié)核性腦膜炎（tuberculous meningitis，TBM）是由結(jié)核分枝桿菌（mycobacterium tuberculosis，Mtb）引起的腦膜非化膿性炎癥性疾病，亦是中樞神經(jīng)系統(tǒng)結(jié)核的最常見類型。目前在全球范圍內(nèi)，結(jié)核性腦膜炎的發(fā)病率呈上升趨勢，死亡率約20-41%[9~11]。結(jié)核性腦膜炎的確診十分困難，臨床上易誤診為病毒性腦膜炎、新型隱球菌性腦膜炎等而延誤治療。隨著免疫學(xué)的發(fā)展，目前已經(jīng)發(fā)現(xiàn)了許多細胞因子在結(jié)核性腦膜炎疾病的發(fā)生發(fā)展中起著非常重要的作用[12,13]。結(jié)核桿菌抗體是在機體感染結(jié)核分枝桿菌后，于抗原的刺激下在組織局部合成的一種蛋白質(zhì)。脂阿拉伯甘露聚糖（lipoarabinomannan，LAM）為結(jié)核分枝桿菌細胞壁脂多糖的主要結(jié)構(gòu)，其作為結(jié)核分枝桿菌細胞壁的表面抗原，特異性強，并具有較強的免疫原性，在感染的宿主體內(nèi)常會引起強烈的抗體反應(yīng)，，能有效刺激機體產(chǎn)生IgG型LAM抗體。本文通過檢測腦脊液LAM-IgG，評估其在早期診斷結(jié)核性腦膜炎的臨床應(yīng)用價值。 目的探討腦脊液中脂阿拉伯甘露聚糖抗體（LAM-IgG）檢測對結(jié)核性腦膜炎的診斷價值。 方法采用酶聯(lián)免疫吸附試驗（ELISA）分別檢測TBM組（46例）、非TBM組（病毒性腦膜炎10例、化膿性腦膜炎12例）和正常對照組（22例）的腦脊液LAM-IgG表達水平。 結(jié)果TBM組患者腦脊液LAM-IgG平均表達水平為0.11±0.027ng/ml，均明顯高于非TBM組中的病毒性腦膜炎組（0.088±0.008ng/ml）、化膿性腦膜炎組（0.09±0.015ng/ml），及正常對照組（0.078±0.016ng/ml），差異具有統(tǒng)計學(xué)意義（P=0.006，P=0.007，P=0.000）。病毒性腦膜炎組、化膿性腦膜炎組及正常對照組三者間比較，差異無統(tǒng)計學(xué)意義（P=0.243，P=0.140，P=0.840）。 結(jié)論檢測腦脊液中LAM-IgG對結(jié)核性腦膜炎的早期診斷及鑒別診斷具有重要的臨床價值。
[Abstract]:Tuberculous meningitis (tuberculous meningitis,TBM) is a non-suppurative inflammatory disease caused by Mycobacterium tuberculosis (mycobacterium tuberculosis,Mtb) and the most common type of tuberculosis in the central nervous system. Worldwide, the incidence of tuberculous meningitis is on the rise, with a mortality rate of 20-41% [9 / 11]. The diagnosis of tuberculous meningitis is very difficult, and is easily misdiagnosed as viral meningitis and Cryptococcus neoformans meningitis. With the development of immunology, many cytokines have been found to play an important role in the development of tuberculous meningitis. Mycobacterium tuberculosis antibody is a protein synthesized locally in tissue after infection with Mycobacterium tuberculosis and stimulated by antigen. Lipoarabannan (lipoarabinomannan,LAM) is the main structure of lipopolysaccharide in the cell wall of Mycobacterium tuberculosis. As the surface antigen of the cell wall of Mycobacterium tuberculosis, it has strong specificity and immunogenicity. A strong antibody response is often caused in the infected host, which can effectively stimulate the production of IgG type LAM antibodies. The clinical value of cerebrospinal fluid (CSF) LAM-IgG, in early diagnosis of tuberculous meningitis was evaluated. Objective to investigate the diagnostic value of LAM-IgG in cerebrospinal fluid (CSF) for tuberculous meningitis. Methods the expression of LAM-IgG in cerebrospinal fluid (CSF) of 46 cases of TBM group, 10 cases of viral meningitis, 12 cases of suppurative meningitis and 22 cases of normal control group were detected by Elisa (ELISA). Results the average expression of LAM-IgG in cerebrospinal fluid in TBM group was 0.11 鹵0.027 ng / ml, which was significantly higher than that in viral meningitis group (0.088 鹵0.008ng/ml) and suppurative meningitis group (0.09 鹵0.015ng/ml). The difference was statistically significant between the control group and the control group (0.078 鹵0.016ng/ml) (P 0. 006, P 0. 007, P 0. 000). There was no significant difference among viral meningitis group, suppurative meningitis group and normal control group (P < 0. 243). Conclusion Detection of LAM-IgG in cerebrospinal fluid has important clinical value in early diagnosis and differential diagnosis of tuberculous meningitis.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R529.3

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