本文關(guān)鍵詞： 結(jié)核性腦膜炎 腦脊液 單核細(xì)胞 結(jié)核桿菌抗原 純化蛋白衍生物 早期分泌抗原靶6　出處：《第四軍醫(yī)大學(xué)》2008年碩士論文　論文類型：學(xué)位論文

【摘要】： 由于多重耐藥結(jié)核菌的流行、人類免疫缺陷病毒的感染及貧窮等多種因素的影響,結(jié)核病發(fā)病率呈日益回升的嚴(yán)重趨勢(shì),結(jié)核性腦膜炎(TBM)的發(fā)病率亦逐漸升高。TBM是嚴(yán)重的中樞神經(jīng)系統(tǒng)感染性疾病,病死率和病殘率均較高,而早期診斷、早期治療是降低病死率、病殘率的關(guān)鍵。目前尚無一種可靠實(shí)用的診斷方法能夠滿足臨床診斷的需要。結(jié)核分支桿菌(MTB)是胞內(nèi)寄生菌,侵入機(jī)體后主要寄生于宿主單核巨噬細(xì)胞內(nèi)。機(jī)體感染MTB后體內(nèi)首先出現(xiàn)的是結(jié)核抗原,而結(jié)核抗原的檢出不受宿主免疫狀態(tài)的影響。故本實(shí)驗(yàn)欲評(píng)價(jià)檢測(cè)腦脊液(CSF)單核細(xì)胞內(nèi)結(jié)核抗原對(duì)TBM診斷的價(jià)值,試圖為TBM的診斷提供一種有效的方法。 本實(shí)驗(yàn)以臨床診斷為中樞神經(jīng)系統(tǒng)感染的85例患者為研究對(duì)象,運(yùn)用免疫細(xì)胞化學(xué)方法檢測(cè)了其CSF和外周血(PB)單核細(xì)胞內(nèi)結(jié)核菌素純化蛋白衍生物(PPD)和早期分泌抗原靶6(ESAT-6),并應(yīng)用流行病學(xué)實(shí)驗(yàn)和分析的方法,以受廣泛認(rèn)可的TBM臨床診斷標(biāo)準(zhǔn)作為“金標(biāo)準(zhǔn)”,把研究對(duì)象分為TBM組(45例)和對(duì)照組(非MTB感染的中樞神經(jīng)系統(tǒng)感染患者40例),評(píng)價(jià)了檢測(cè)CSF和PB單核細(xì)胞內(nèi)PPD及ESAT-6抗原診斷TBM的價(jià)值。 實(shí)驗(yàn)結(jié)果:1.檢測(cè)CSF單核細(xì)胞內(nèi)PPD抗原,TBM組39例有陽性染色,對(duì)照組10例有陽性染色;檢測(cè)ESAT-6抗原,TBM組39例有陽性染色,對(duì)照組6例有陽性染色。2.檢測(cè)PB單核細(xì)胞內(nèi)結(jié)核抗原,PPD和ESAT-6結(jié)果一致,TBM組11例有陽性染色,對(duì)照組無陽性染色。3.檢測(cè)CSF單核細(xì)胞內(nèi)PPD抗原和ESAT-6抗原診斷結(jié)腦的敏感度均為86.7%,特異度分別為87.5%和92.5%。4.檢測(cè)PB單核細(xì)胞內(nèi)PPD抗原和ESAT-6抗原診斷結(jié)腦的敏感度均為24.4%,特異度均為100%。5.TBM組CSF和PB的PPD、ESAT-6陽性細(xì)胞百分率均顯著高于對(duì)照組(P0.001)。6.TBM組CSF的PPD、ESAT-6陽性細(xì)胞百分率均顯著高于PB(P0.001)。 結(jié)論:免疫細(xì)胞化學(xué)方法檢測(cè)CSF單核細(xì)胞內(nèi)結(jié)核抗原診斷TBM的靈敏度和特異度均較理想,且容易開展,可用于TBM的診斷,值得推廣應(yīng)用。而檢測(cè)PB單核細(xì)胞內(nèi)結(jié)核抗原診斷TBM的靈敏度較低,價(jià)值有限。
[Abstract]:Due to the prevalence of multidrug resistant tuberculosis, the infection of human immunodeficiency virus and poverty, the incidence of tuberculosis is increasing gradually. The incidence of tuberculous meningitis (TBM) also increased gradually. TBM is a serious infectious disease of the central nervous system. The mortality and disability rate of TBM are high, and the early diagnosis and treatment is to reduce the mortality. At present, there is no reliable and practical diagnostic method to meet the need of clinical diagnosis. Mycobacterium tuberculosis (MTB) is an intracellular parasite. After invading the body, it is mainly parasitic in the host mononuclear macrophages. After the body is infected with MTB, the first antigen that appears in the body is tuberculosis antigen. But the detection of tuberculosis antigen is not affected by the host immune state. Therefore, the purpose of this study is to evaluate the value of detecting monocyte tuberculosis antigen in cerebrospinal fluid (CSF) for the diagnosis of TBM, in order to provide an effective method for the diagnosis of TBM. In this study, 85 patients with central nervous system infection were studied. Immunocytochemistry was used to detect the purified protein derivative of tuberculin in monocytes of CSF and peripheral blood mononuclear cells (PPDs) and the early secretory antigen target 6ESAT-6. The methods of epidemiological experiment and analysis were used. Based on the widely accepted clinical diagnostic criteria of TBM, the study subjects were divided into two groups: TBM group (n = 45) and control group (n = 40). The detection of PPD in CSF and PB monocytes was evaluated. And the value of ESAT-6 antigen in the diagnosis of TBM. The positive staining was observed in 39 cases of CSF monocytes and 10 cases in control group, and 39 cases in ESAT-6 antigen group. Positive staining was found in 6 cases of control group. PPD and ESAT-6 showed positive staining in 11 cases of PB monocyte tuberculosis antigen. The sensitivity of detecting PPD antigen and ESAT-6 antigen in CSF monocytes was 86.7, and the specificity was 87.5% and 92.5.4.The sensitivity of detecting PPD antigen and ESAT-6 antigen in PB monocytes was 24. 4%. 5. The percentage of PPD-ESAT-6 positive cells in CSF and PB in TBM group was significantly higher than that in control group (P0.001). 6. The percentage of PPD-ESAT-6 positive cells in CSF group was significantly higher than that in P0.001TBM group. Conclusion: the sensitivity and specificity of immunocytochemistry for the detection of CSF monocyte tuberculosis antigen in the diagnosis of TBM are ideal and easy to develop. It can be used in the diagnosis of TBM. It is worth popularizing application, but the sensitivity of detecting PB monocyte tuberculosis antigen in TBM is low, and the value is limited.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R392

【引證文獻(xiàn)】

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本文編號(hào)：1501253