麦迪娜·阿地里;吐尔洪·吐尔逊;吐尔逊·沙比尔;

• 1:新疆医科大学第一附属医院神经内科
• 2:新疆医科大学第一附属医院重症医学科

摘要(Abstract)：

目的探讨脑脊液腺苷脱氨酶(CSF-ADA)与血清5’-核苷酸酶(5’-NT)在结核性脑膜炎诊断与鉴别诊断中的价值。方法回顾性分析40例结核性脑膜炎患者(病例组)与36例病毒性脑膜炎患者(对照组)的一般资料、脑脊液、血液学及影像学检查结果,重点探讨CSF-ADA与血清5’-NT在结核性脑膜炎中的诊断价值。结果病例组CSF-ADA和血清5’-NT水平显著高于对照组(P<0.001)。根据CSF-ADA与血清5’-NT的接收者操作特性曲线(ROC),CSF-ADA>4.40 U/L或血清5’-NT>4.85 U/L被认为是诊断的阳性结果,显示出高的敏感性与特异性,CSF-ADA的敏感度为92.5%,特异度为89%;血清5’-NT的敏感度为95%,特异度为70%。当联合CSF-ADA与血清5’-NT诊断结核性脑膜炎,即CSF-ADA>4.40 U/L或(和)血清5’-NT>4.85 U/L,其敏感性最高,其灵敏度为97.5%,特异度为73.5%,阳性似然比(PLR)为3.68,阴性似然比(NLR)为0.03。结论在结核性脑膜炎的诊断中,CSF-ADA与血清5’-NT可以起到快速、简单、相对准确的诊断作用。当CSF-ADA或(和)血清5’-NT明显升高时,可尽早怀疑结核性脑膜炎,同时结合临床表现、其他脑脊液、血液学及影像学结果综合诊断。

关键词(KeyWords)： 脑脊液;腺苷脱氨酶;5’-核苷酸酶;结核性脑膜炎;病毒性脑膜炎

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 麦迪娜·阿地里;吐尔洪·吐尔逊;吐尔逊·沙比尔;

参考文献(References)：

• [1] ZUMLA A,GEORGE A,SHARMA V,et al.The WHO 2014 global tuberculosis report--further to go[J].Lancet Global Health,2015,3(1):e10-e12.
• [2] GUPTA B K,BHARAT A,DEBAPRIYA B,et al.Adenosine Deaminase Levels in CSF of Tuberculous Meningitis Patients[J].J Clin Med Res,2010,2(5):220-224.
• [3] LEKHAK S P,SHARMA L,RAJBHANDARI R,et al.Evaluation of multiplex PCR using MPB64 and IS6110 primers for rapid diagnosis of tuberculous meningitis[J].Tuberculosis,2016,100:1-4.
• [4] FLINN A M,GENNERY A R.Adenosine deaminase deficiency:a review[J].Orphanet J Rare Dis,2018,13(1):65.
• [5] KARSEN H,KORUK S T,KARAHOCAGIL M K,et al.Comparative analysis of cerebrospinal fluid adenosine deaminase activity in meningitis[J].Swiss Med Weekly,2011,141:w13214.
• [6] 段钧.脑脊液腺苷脱氨酶在小儿结核性脑膜炎中的应用价值[J].中国实用神经疾病杂志,2016,19(5):51-53.
• [7] RAVIRA J,HENRY R A,RAO G G.Determination and Validation of a Lower Cut Off Value of Cerebrospinal Fluid Adenosine Deaminase (CSF-ADA) Activity in Diagnosis of Tuberculous Meningitis[J].J Clin Diagn Res,2017,11(4):OC22-OC24.
• [8] ROSI F,TABUCCHI A,CARLUCCI F,et al.5′-Nucleotidase Activity in Lymphocytes From Patients Affected by B-Cell Chronic Lymphocytic Leukemia[J].Clin Biochem,1998,31(4):269-272.
• [9] SCHETINGER M R,MORSCH V M,BONAN C D,et al.NTPDase and 5'-nucleotidase activities in physiological and disease conditions:New perspectives for human health[J].BioFactors,2007,31(2):77-98.
• [10] PETIT-JENTREAU L,JOUVION G,CHARLES P,et al.Ecto-5'-Nucleotidase (CD73) Deficiency in Mycobacterium tuberculosis-Infected Mice Enhances Neutrophil Recruitment[J].Infect Immun,2015,83(9):3666-3674.
• [11] THWAITES G E,VAN TOORN R,SCHOEMAN J.Tuberculous meningitis:more questions,still too few answers[J].Lancet Neurol,2013,12(10):999-1010.
• [12] SUN Q,SHA W,XIAO H P,et al.Evaluation of Cerebrospinal Fluid Adenosine Deaminase Activity for the Differential Diagnosis of Tuberculous and Nontuberculous Meningitis[J].Am J Med Sci,2012,344(2):116-121.
• [13] JAKKA S R,VEENA S,ATMAKURI R M,et al.Characteristic abnormalities in cerebrospinal fluid biochemistry in children with cerebral malaria compared to viral encephalitis[J].Cerebrospinal Fluid Res,2006,3(1):8.
• [14] MEHRNAZ R,JALIL M S,REZA A E,et al.Serum adenosine deaminase activity and c-reactive protein levels in patients with brucellosis[J].Iranian J Pathol,2009,9(3).
• [15] TUON F F,HIGASHINO H R,LOPES M I,et al.Adenosine deaminase and tuberculous meningitis-a systematic review with meta-analysis[J].Scand J Infect Dis,2010,42(3):198-207.
• [16] SHENOY V,SINGH K,PRABHU K,et al.Evaluation of usefulness of pleural fluid adenosine deaminase in diagnosing tuberculous pleural effusion from empyema[J].Asian Pacific Journal of Tropical Disease,2014,4(Suppl 1):S411-S414.
• [17] IDZKO M,FERRARI D,ELTZSCHIG H K.Nucleotide signalling during inflammation[J].Nature,2014,509(7 500):310-317.
• [18] DALH CHRISTENSEN L,SVENSON M,NYGAARD P,et al.Decreased B lymphocyte ecto-5'nucleotidase and increased adenosine deaminase in mononuclear cells from patients infected with human immunodeficiency virus[J].APMIS,1988,96(10):882-888.
• [19] CHEN Z,SHAO X Y,WANG C,et al.Mycobacterium marinum Infection in Zebrafish and Microglia Imitates the Early Stage of Tuberculous Meningitis[J].J Mol Neurosci,2018,64(2):321-330.
• [20] GALIMI R.Extrapulmonary tuberculosis:tuberculous meningitis new developments[J].Eur Rev Med Pharmacol Sci,2011,15(4):365-386.
• [21] VAN LEEUWEN L M,VAN DER KUIP M,YOUSSEF S A,et al.Modeling tuberculous meningitis in zebrafish using Mycobacterium marinum[J].Dis Mod Mech,2014,7(9):1111-1122.
• [22] GOMEZ-BELDARRAIN M,GARCíA-MONCó J C.Lumbar Puncture and CSF Analysis and Interpretation[M]// García-Moncó JC,editor.CNS Infections:A Clinical Approach.London:Springer London,2014:1-16.