中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
14期
1705-1707,1710
,共4页
汤海燕%谈鹰%张栗
湯海燕%談鷹%張慄
탕해연%담응%장률
结核,脑膜%化脓性脑膜炎%脑脊液%血浆%生化指标%比值
結覈,腦膜%化膿性腦膜炎%腦脊液%血漿%生化指標%比值
결핵,뇌막%화농성뇌막염%뇌척액%혈장%생화지표%비치
Tuberculosis,meninges%Purulent meningitis%Cerebrospinal fluid%Plasma%Biochemical indices%Ratio
目的：探讨脑脊液（CSF）与血浆生化指标比值对结核性脑膜炎与化脓性脑膜炎的鉴别意义。方法选取2007年1月—2013年12月湖州市中心医院神经内科及感染科收治的结核性脑膜炎患者55例（结核性脑膜炎组），化脓性脑膜炎患者73例（化脓性脑膜炎组）。采集患者静脉血及 CSF 标本，测定其 CSF 及血浆糖、蛋白、腺苷脱氨酶（ADA）和氯化物含量，并计算 CSF/血浆中上述生化指标的比值。结果两组 CSF 糖、蛋白含量比较，差异无统计学意义（P ＞0.05）；结核性脑膜炎组氯化物含量低于化脓性脑膜炎组，ADA 含量高于化脓性脑膜炎组（P ＜0.05）。两组血浆糖含量比较，差异无统计学意义（P ＞0.05）；结核性脑膜炎组蛋白、氯化物含量低于化脓性脑膜炎组，ADA 含量高于化脓性脑膜炎组（P ＜0.05）。两组 CSF/血浆糖比值比较，差异无统计学意义（P ＞0.05）；结核性脑膜炎组蛋白比值、ADA 比值高于化脓性脑膜炎组，氯化物比值低于化脓性脑膜炎组（P ＜0.05）。绘制 CSF/血浆 ADA 比值联合氯化物比值诊断结核性脑膜炎的 ROC 曲线，选取切点 ADA 比值≥1.19且氯化物比值≤0.93时，灵敏度为78.2％，特异度为78.1％，曲线下面积为0.836。结论 CSF 中 ADA、氯化物含量和 CSF/血浆蛋白、ADA、氯化物比值在结核性脑膜炎中有特定意义，特别是 CSF/血浆 ADA 比值≥1.19联合氯化物比值≤0.93时对结核性脑膜炎的诊断意义较大，有助于临床医生鉴别结核性脑膜炎和化脓性脑膜炎。
目的：探討腦脊液（CSF）與血漿生化指標比值對結覈性腦膜炎與化膿性腦膜炎的鑒彆意義。方法選取2007年1月—2013年12月湖州市中心醫院神經內科及感染科收治的結覈性腦膜炎患者55例（結覈性腦膜炎組），化膿性腦膜炎患者73例（化膿性腦膜炎組）。採集患者靜脈血及 CSF 標本，測定其 CSF 及血漿糖、蛋白、腺苷脫氨酶（ADA）和氯化物含量，併計算 CSF/血漿中上述生化指標的比值。結果兩組 CSF 糖、蛋白含量比較，差異無統計學意義（P ＞0.05）；結覈性腦膜炎組氯化物含量低于化膿性腦膜炎組，ADA 含量高于化膿性腦膜炎組（P ＜0.05）。兩組血漿糖含量比較，差異無統計學意義（P ＞0.05）；結覈性腦膜炎組蛋白、氯化物含量低于化膿性腦膜炎組，ADA 含量高于化膿性腦膜炎組（P ＜0.05）。兩組 CSF/血漿糖比值比較，差異無統計學意義（P ＞0.05）；結覈性腦膜炎組蛋白比值、ADA 比值高于化膿性腦膜炎組，氯化物比值低于化膿性腦膜炎組（P ＜0.05）。繪製 CSF/血漿 ADA 比值聯閤氯化物比值診斷結覈性腦膜炎的 ROC 麯線，選取切點 ADA 比值≥1.19且氯化物比值≤0.93時，靈敏度為78.2％，特異度為78.1％，麯線下麵積為0.836。結論 CSF 中 ADA、氯化物含量和 CSF/血漿蛋白、ADA、氯化物比值在結覈性腦膜炎中有特定意義，特彆是 CSF/血漿 ADA 比值≥1.19聯閤氯化物比值≤0.93時對結覈性腦膜炎的診斷意義較大，有助于臨床醫生鑒彆結覈性腦膜炎和化膿性腦膜炎。
목적：탐토뇌척액（CSF）여혈장생화지표비치대결핵성뇌막염여화농성뇌막염적감별의의。방법선취2007년1월—2013년12월호주시중심의원신경내과급감염과수치적결핵성뇌막염환자55례（결핵성뇌막염조），화농성뇌막염환자73례（화농성뇌막염조）。채집환자정맥혈급 CSF 표본，측정기 CSF 급혈장당、단백、선감탈안매（ADA）화록화물함량，병계산 CSF/혈장중상술생화지표적비치。결과량조 CSF 당、단백함량비교，차이무통계학의의（P ＞0.05）；결핵성뇌막염조록화물함량저우화농성뇌막염조，ADA 함량고우화농성뇌막염조（P ＜0.05）。량조혈장당함량비교，차이무통계학의의（P ＞0.05）；결핵성뇌막염조단백、록화물함량저우화농성뇌막염조，ADA 함량고우화농성뇌막염조（P ＜0.05）。량조 CSF/혈장당비치비교，차이무통계학의의（P ＞0.05）；결핵성뇌막염조단백비치、ADA 비치고우화농성뇌막염조，록화물비치저우화농성뇌막염조（P ＜0.05）。회제 CSF/혈장 ADA 비치연합록화물비치진단결핵성뇌막염적 ROC 곡선，선취절점 ADA 비치≥1.19차록화물비치≤0.93시，령민도위78.2％，특이도위78.1％，곡선하면적위0.836。결론 CSF 중 ADA、록화물함량화 CSF/혈장단백、ADA、록화물비치재결핵성뇌막염중유특정의의，특별시 CSF/혈장 ADA 비치≥1.19연합록화물비치≤0.93시대결핵성뇌막염적진단의의교대，유조우림상의생감별결핵성뇌막염화화농성뇌막염。
Objective To explore the value of the ratios of cerebrospinal fluid(CSF)to plasma biochemical indices in identifying tuberculous meningitis( TBM) and purulent meningitis( PM). Methods We enrolled 55 patients with TBM (TBM group)and 73 patients with PM(PM group)from the Department of Neurology of Huzhou Central Hospital from January 2007 to December 2013. Venous blood and CSF samples were collected. The glucose,protein,ADA and chloride content in CSF and plasma were examined. And the ratios of CSF to plasma biochemical indices were calculated. Results The two groups were not significantly different(P > 0. 05)in the glucose and protein content in CSF;the TBM group was lower(P < 0. 05)in CSF chloride content and was higher(P < 0. 05) in CSF ADA content than PM group. The two groups were not significantly different(P > 0. 05)in the glucose content in plasma;the TBM group was lower(P < 0. 05) in plasma chloride and protein content and was higher(P < 0. 05)in plasma ADA content than PM group. The two groups were not significantly different(P >0. 05)in the CSF/ plasma glucose content ratio;the TBM group was higher(P < 0. 05)in the protein and ADA ratio and lower (P < 0. 05)in chloride ratio than PM group. In the ROC curve for diagnosing TBM combining ADA and chloride ratio and at the point of tangency with CSF/ plasma ADA ratio ≥1. 19 and CSF/ plasma chloride ratio ≤0. 93,the sensitivity degree was 78. 2% , the specificity degree was 78. 1% and the area under curve was 0. 836. Conclusion The content of ADA and chloride in CSF and CSF/ plasma protein,ADA and chloride ratios are of particular significance in TBM. Especially when ADA ratio ≥1. 19 and chloride ratio ≤0. 93,the indices are of great importance in diagnosing TBM accurately and distinguishing TBM from PM.
