CAJ | 학술논문

目的探讨脑脊液生物学标志物检测对于脑膜癌病(MC)和结核性脑膜炎(TBM)的鉴别意义. 方法回顾性分析解放军总医院神经内科自1994年1月至2014年8月收治的34例MC及44例TBM患者的临床资料,对比其主要临床表现及脑脊液检查结果. 结果 MC患者以头痛和恶心呕吐为主要临床表现,TBM患者以发热和头痛为主要表现.2组患者脑脊液细胞总数均明显增多,但TBM组细胞总数明显高于MC组,差异有统计学意义(P＜0.05);脑脊液蛋白含量均升高,葡萄糖及氯化物含量均下降,但TBM组脑脊液蛋白升高更显著,差异有统计学意义(P＜0.05).MC及TBM患者的脑脊液生物学标志物均不同程度升高,癌胚抗原(CEA)、癌抗原125(CA125)、癌抗原199(CA199)、癌抗原153(CA153)、非小细胞肺癌相关抗原(CYFRA 21-1)水平在MC组显著高于各期TBM,差异均有统计学意义(P＜0.05);Ⅲ期TBM患者神经元特异性烯醇化酶(NSE)水平显著高于MC患者,差异有统计学意义(P＜0.05). 结论脑脊液生物学标志物检测可作为鉴别MC及各期TBM的重要依据,其中CEA、CA125、CA199、CYFRA21-1及NSE同步联合检测有重要意义.
목적 탐토뇌척액생물학표지물검측대우뇌막암병(MC)화결핵성뇌막염(TBM)적감별의의. 방법 회고성분석해방군총의원신경내과자1994년1월지2014년8월수치적34례MC급44례TBM환자적림상자료,대비기주요림상표현급뇌척액검사결과. 결과 MC환자이두통화악심구토위주요림상표현,TBM환자이발열화두통위주요표현.2조환자뇌척액세포총수균명현증다,단TBM조세포총수명현고우MC조,차이유통계학의의(P＜0.05);뇌척액단백함량균승고,포도당급록화물함량균하강,단TBM조뇌척액단백승고경현저,차이유통계학의의(P＜0.05).MC급TBM환자적뇌척액생물학표지물균불동정도승고,암배항원(CEA)、암항원125(CA125)、암항원199(CA199)、암항원153(CA153)、비소세포폐암상관항원(CYFRA 21-1)수평재MC조현저고우각기TBM,차이균유통계학의의(P＜0.05);Ⅲ기TBM환자신경원특이성희순화매(NSE)수평현저고우MC환자,차이유통계학의의(P＜0.05). 결론 뇌척액생물학표지물검측가작위감별MC급각기TBM적중요의거,기중CEA、CA125、CA199、CYFRA21-1급NSE동보연합검측유중요의의.
Objective To investigate the diagnostic value ofbiomarkers in cerebrospinal fluid in differentiating meningeal carcinomatosis (MC) and tubercular meningitis (TBM).Methods The clinical features and cerebrospinal fluid (CSF) test results of 34 patients with MC and 44 patients with TBM,admitted to our hospital from January 1994 to August 2014,were retrospectively analyzed and compared.Results The main clinical manifestations of MC included headache and bowel and bladder dysfunction,and those of TBM were fever and headache.The cell population of MC and TBM patients increased and the number of leucocyte of TBM patients was significantly larger than that of MC patients (P＜0.05);the CSF of all the patients presented with decreased levels of glucose and chloride,and increased protein level,and higher protein in MC patients was noted than that in TBM patients (P＜0.05).The biomarkers in CSF of MC and TBM patients increased to varying degrees,and the biomarkers,including carcinoembryonic antigen (CEA),cancer antigen (CA) 125,CA 199,CA 153 and CYFRA21-1,in MC group were significantly higher than those in TBM group (P＜0.05).The neuron-specific enolase level in the TBM patients of Ⅲ grade was significantly higher than that in the MC patients (P＜ 0.05).Conclusion The detections of tumor biomarkers in cerebrospinal fluid is a tool in differentiating MC and all stages of TBM,especially with the combined detections of CEA,CA125,CA199 and CYFRA21-1.