中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
33期
12-15
,共4页
磷酸丙酮酸水合酶%基质金属蛋白酶9%腺苷脱氨酶%结核,脑膜
燐痠丙酮痠水閤酶%基質金屬蛋白酶9%腺苷脫氨酶%結覈,腦膜
린산병동산수합매%기질금속단백매9%선감탈안매%결핵,뇌막
Phosphopyruvate hydratase%Matrix metalloproteinase 9%Adenosine deaminase%Tuberculosis,meningeal
目的 研究脑脊液中神经元特异性烯醇化酶(NSE)、基质金属蛋白酶-9(MMP-9)、腺苷脱氨酶(ADA)及肿瘤坏死因子-α(TNF-α)水平对结核性脑膜炎(TBM)的临床诊断价值.方法 选取57例临床确诊的TBM患者作为TBM组,选取同期住院的非TBM患者49例(包括病毒性脑膜炎31例,非结核性细菌性脑膜炎18例)作为对照组,比较两组患者的临床表现和入院后24h内及治疗后恢复期脑脊液中NSE、MMP-9、ADA及TNF-α水平.结果 TBM组头痛、发热、脑膜刺激征、意识障碍发生率分别为89.5％(51/57)、93.0％(53/57)、86.0％(49/57)和56.1％(32/57),对照组分别为91.8％(45/49)、95.9％(47/49)、85.7％(42/49)和59.2％(29/49),两组比较差异无统计学意义(P＞0.05).入院后24h内TBM组脑脊液中NSE、MMP-9、ADA及TNF-α水平分别为(17.2±6.3) μg/L、(82.3±14.5) μg/L、(14.5±5.4) U/L和(87.9±16.1) μg/L,均显著高于对照组的(11.7±4.2)μg/L、(42.9±11.3) μg/L、(4.3±2.0) U/L和(79.3±14.6) μg/L,差异有统计学意义(P＜0.05)；治疗后恢复期TBM组脑脊液中NSE、MMP-9、ADA及TNF-α水平分别为(6.5±2.1)μg/L、(16.7±4.1) μg/L、(6.1±2.3) U/L和(41.7±12.8) μg/L,对照组分别为(6.3±2.3) μg/L、(12.1±3.2) μg/L、(4.1±2.1)U/L和(32.9±11.3)μg/L,TBM组治疗后恢复期脑脊液中NSE水平与对照组比较差异无统计学意义(P＞0.05),MMP-9、ADA及TNF-α水平仍高于对照组,差异有统计学意义(P＜0.05)；两组治疗后恢复期脑脊液中NSE、MMP-9、ADA及TNF-α水平均较入院后24h内显著下降,差异有统计学意义(P＜0.05).TBM组中急性起病者(38例)入院后24h内脑脊液中NSE、MMP-9、ADA水平分别为(19.5±6.7) μg/L、(87.9±16.1) μg/L、(17.2±6.3) U/L,均显著高于亚急性起病者(19例)的(14.9±5.1) μg/L、(76.7±13.5) μg/L、(11.8±5.1) U/L,差异有统计学意义(P＜ 0.05或＜0.01),TNF-α水平比较差异无统计学意义(P＞0.05).结论 脑脊液中NSE、MMP-9、ADA及TNF-α水平可为TBM的早期诊断及鉴别诊断提供依据.
目的 研究腦脊液中神經元特異性烯醇化酶(NSE)、基質金屬蛋白酶-9(MMP-9)、腺苷脫氨酶(ADA)及腫瘤壞死因子-α(TNF-α)水平對結覈性腦膜炎(TBM)的臨床診斷價值.方法 選取57例臨床確診的TBM患者作為TBM組,選取同期住院的非TBM患者49例(包括病毒性腦膜炎31例,非結覈性細菌性腦膜炎18例)作為對照組,比較兩組患者的臨床錶現和入院後24h內及治療後恢複期腦脊液中NSE、MMP-9、ADA及TNF-α水平.結果 TBM組頭痛、髮熱、腦膜刺激徵、意識障礙髮生率分彆為89.5％(51/57)、93.0％(53/57)、86.0％(49/57)和56.1％(32/57),對照組分彆為91.8％(45/49)、95.9％(47/49)、85.7％(42/49)和59.2％(29/49),兩組比較差異無統計學意義(P＞0.05).入院後24h內TBM組腦脊液中NSE、MMP-9、ADA及TNF-α水平分彆為(17.2±6.3) μg/L、(82.3±14.5) μg/L、(14.5±5.4) U/L和(87.9±16.1) μg/L,均顯著高于對照組的(11.7±4.2)μg/L、(42.9±11.3) μg/L、(4.3±2.0) U/L和(79.3±14.6) μg/L,差異有統計學意義(P＜0.05)；治療後恢複期TBM組腦脊液中NSE、MMP-9、ADA及TNF-α水平分彆為(6.5±2.1)μg/L、(16.7±4.1) μg/L、(6.1±2.3) U/L和(41.7±12.8) μg/L,對照組分彆為(6.3±2.3) μg/L、(12.1±3.2) μg/L、(4.1±2.1)U/L和(32.9±11.3)μg/L,TBM組治療後恢複期腦脊液中NSE水平與對照組比較差異無統計學意義(P＞0.05),MMP-9、ADA及TNF-α水平仍高于對照組,差異有統計學意義(P＜0.05)；兩組治療後恢複期腦脊液中NSE、MMP-9、ADA及TNF-α水平均較入院後24h內顯著下降,差異有統計學意義(P＜0.05).TBM組中急性起病者(38例)入院後24h內腦脊液中NSE、MMP-9、ADA水平分彆為(19.5±6.7) μg/L、(87.9±16.1) μg/L、(17.2±6.3) U/L,均顯著高于亞急性起病者(19例)的(14.9±5.1) μg/L、(76.7±13.5) μg/L、(11.8±5.1) U/L,差異有統計學意義(P＜ 0.05或＜0.01),TNF-α水平比較差異無統計學意義(P＞0.05).結論 腦脊液中NSE、MMP-9、ADA及TNF-α水平可為TBM的早期診斷及鑒彆診斷提供依據.
목적 연구뇌척액중신경원특이성희순화매(NSE)、기질금속단백매-9(MMP-9)、선감탈안매(ADA)급종류배사인자-α(TNF-α)수평대결핵성뇌막염(TBM)적림상진단개치.방법 선취57례림상학진적TBM환자작위TBM조,선취동기주원적비TBM환자49례(포괄병독성뇌막염31례,비결핵성세균성뇌막염18례)작위대조조,비교량조환자적림상표현화입원후24h내급치료후회복기뇌척액중NSE、MMP-9、ADA급TNF-α수평.결과 TBM조두통、발열、뇌막자격정、의식장애발생솔분별위89.5％(51/57)、93.0％(53/57)、86.0％(49/57)화56.1％(32/57),대조조분별위91.8％(45/49)、95.9％(47/49)、85.7％(42/49)화59.2％(29/49),량조비교차이무통계학의의(P＞0.05).입원후24h내TBM조뇌척액중NSE、MMP-9、ADA급TNF-α수평분별위(17.2±6.3) μg/L、(82.3±14.5) μg/L、(14.5±5.4) U/L화(87.9±16.1) μg/L,균현저고우대조조적(11.7±4.2)μg/L、(42.9±11.3) μg/L、(4.3±2.0) U/L화(79.3±14.6) μg/L,차이유통계학의의(P＜0.05)；치료후회복기TBM조뇌척액중NSE、MMP-9、ADA급TNF-α수평분별위(6.5±2.1)μg/L、(16.7±4.1) μg/L、(6.1±2.3) U/L화(41.7±12.8) μg/L,대조조분별위(6.3±2.3) μg/L、(12.1±3.2) μg/L、(4.1±2.1)U/L화(32.9±11.3)μg/L,TBM조치료후회복기뇌척액중NSE수평여대조조비교차이무통계학의의(P＞0.05),MMP-9、ADA급TNF-α수평잉고우대조조,차이유통계학의의(P＜0.05)；량조치료후회복기뇌척액중NSE、MMP-9、ADA급TNF-α수평균교입원후24h내현저하강,차이유통계학의의(P＜0.05).TBM조중급성기병자(38례)입원후24h내뇌척액중NSE、MMP-9、ADA수평분별위(19.5±6.7) μg/L、(87.9±16.1) μg/L、(17.2±6.3) U/L,균현저고우아급성기병자(19례)적(14.9±5.1) μg/L、(76.7±13.5) μg/L、(11.8±5.1) U/L,차이유통계학의의(P＜ 0.05혹＜0.01),TNF-α수평비교차이무통계학의의(P＞0.05).결론 뇌척액중NSE、MMP-9、ADA급TNF-α수평가위TBM적조기진단급감별진단제공의거.
Objective To study the application of neuron-specific enolase (NSE),matrix metalloproteinase-9 (MMP-9),adenosine deaminase (ADA) and tumor necrosis factor-alpha (TNF-α)level in cerebrospinal fluid for diagnosis of tuberculous meningitis (TBM).Methods The clinical manifestations,and NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid on admission and convalescence were compared between 57 patients with TBM (TBM group) and 49 patients with non-TBM (non-TBM group,including 3.1 cases of viral meningitis and 18 cases of non-tuberculous bacterial meningitis).Results The headache,fever,meningeal irritation,disturbance of consciousness,respectively accounted for 89.5％ (51/57),93.0％ (53/57),86.0％ (49/57) and 56.1％ (32/57) in TBM group,91.8％ (45/49),95.9％(47/49),85.7％ (42/49) and 59.2％(29/49) in control group,there was no significant difference between two groups (P ＞ 0.05).NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid of TBM group on admission were (17.2±6.3) μg/L,(82.3 ± 14.5) μg/L,(14.5 ±5.4) U/L,(87.9 ± 16.1) μ g/L,which were higher than those of control group [(11.7 ± 4.2) μg/L,(42.9 ± 11.3) μg/L,(4.3 ±2.0) U/L,(79.3 ± 14.6) μg/L],there were significant differences (P ＜ 0.05).NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid of TBM group on convalescence decreased to (6.5 ± 2.1) μg/L,(16.7 ± 4.1) μg/L,(6.1 ± 2.3) U/L and (41.7 ± 12.8) μg/L,while which of control group were (6.3 ± 2.3) μg/L,(12.1 ± 3.2)μg/L,(4.1 ±2.1) U/L and (32.9 ± 11.3)μg/L The above-mentioned factors in both groups were all significandy decreased (P ＜0.05),but MMP-9,ADA and TNF-α levels in cerebrcepinal fluid of TBM group were still higher than those of control group (P ＜ 0.05).NSE,MMP-9 and ADA levels in cerebrospinal fluid of acute onset TBM patients (38 cases) on admission were (19.5 ± 6.7) μg/L,(87.9 ± 16.1) μg/L and (17.2 ± 6.3) U/L,which were significantly higher than those of subacute onset TBM patients (19 cases)[(14.9 ±5.1) μg/L,(76.7 ± 13.5) μg/L and (11.8 ±5.1) U/L] (P ＜0.05 or ＜0.01),there was no significant difference in TNF-α levels(P＞ 0.05).Conclusion NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid may provide the evidence for early diagnosis and differential diagnosis of TBM.
