王娟娟++++++马利

[摘要] 目的 探討外周血T细胞斑点试验（T-SPOT.TB）、脑脊液结核分枝杆菌培养及结核菌素试验（PPD试验）在结核性脑膜炎诊断中的应用价值。 方法 选择2015年1月～2016年12月延安大学附属医院收治的疑似结核性脑膜炎患者65例为研究对象，所有患者均行外周血T-SPOT.TB、脑脊液结核分枝杆菌培养及PPD试验。观察比较3种检测方法的在结核性脑膜炎诊断中的灵敏度、特异度等。 结果 65例患者中，35例为结核性脑膜炎患者，30例为非结核性脑膜炎患者。结核性脑膜炎患者中，T-SPOT.TB阳性率为74.29%，明显高于结核分枝杆菌培养及PPD试验的阳性率（40.00%，57.14%），且PPD试验阳性率高于结核分枝杆菌培养，差异有统计学意义（P < 0.05）。在非结核性脑膜炎患者中，PPD试验阳性率为26.27%，明显高于T-SPOT.TB及结核分枝杆菌培养的阳性率（10.00%，0.00%），差异有统计学意义（P < 0.05）。在结核性脑膜炎诊断中，T-SPOT.TB的敏感度、特异度、阳性预测值、阴性预测值分别为89.66%、75.00%、74.29%、90.00%，均明显高于PPD试验的71.43%、59.46%、57.14%、73.33%，差异有统计学意义（P < 0.05）；T-SPOT.TB在结核性脑膜炎诊断中的特异度、阳性预测值均高于结核分枝杆菌培养的52.63%、40.00%，差异有统计学意义（P < 0.05）。 结论 外周血T-SPOT.TB检测在结核性脑膜炎诊断中具有较高的敏感度、特异度，有助于结核性脑膜炎的快速诊断，值得临床推广。

[关键词] 结核性脑膜炎；外周血；T细胞斑点试验； 结核分枝杆菌培养；结核菌素试验；诊断

[中图分类号] R529.3 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0119-04

Application value of different testing methods in the diagnosis of tuberculous meningitis

WANG Juanjuan MA Li▲

Department of Neurology， Yan 'an University Affiliated Hospital， Shaanxi Province， Yan'an 716000， China

[Abstract] Objective To explore the application value of peripheral blood T-SPOT.TB， cerebrospinal fluid mycobacterium tuberculosis culture and tuberculin test （PPD test） in the diagnosis of tuberculous meningitis. Methods 65 cases of patients suspected tuberculous meningitis from January 2015 to December 2016 in Yan 'an University Affiliated Hospital were chosen as the research objects. All patients were given the test of peripheral blood T-SPOT.TB， cerebrospinal fluid mycobacterium tuberculosis culture and PPD test. The sensitivity， specificity in the diagnosis of tuberculous meningitis were compared among the three testing methods. Results Among 65 patients， there were 35 cases with tuberculous meningitis and 30 cases with non-tuberculous meningitis. In patients with tuberculous meningitis， the positive rate of T-SPOT.TB test was 74.29%， and it was significantly higher than that of mycobacterium tuberculosis cultivate and PPD test （40.00%， 57.14%）， and the positive rate of the PPD test was higher than that of mycobacterium tuberculosis culture， with statistically significant differences （P < 0.05）. In patients with non-tuberculous meningitis， the positive rate of PPD test was 26.27%， which was significantly higher than that of T-SPOT.TB and mycobacterium tuberculosis culture （10.00%， 0.00%）， with statistically significant differences （P < 0.05）. In the diagnosis of tuberculous meningitis， the sensitivity， specificity， positive predictive value， negative predictive value of T-SPOT.TB was 89.66%， 75.00%， 74.29%， 90.00% respectively， which were significantly higher than 71.43%， 59.46%， 57.14%， 73.33% of PPD test， with statistically significant differences （P < 0.05）； the specificity and positive predictive value of T-SPOT. TB were higher than those of the mycobacterium tuberculosis culture （52.63%， 40.00%）， with statistically significant differences （P < 0.05）. Conclusion Peripheral blood T-SPOT.TB test in the diagnosis of tuberculous meningitis has high sensitivity and specificity， which is helpful for the rapidly diagnosing tuberculous meningitis. It is worthy of clinical promotion.

[Key words] Tuberculous meningitis； Peripheral blood； T cells spot test； Mycobacterium tuberculosis culture； Tuberculin test； Diagnosis

结核性脑膜炎是由结核分枝杆菌引起脑膜、脊膜的非化脓性炎症性疾病，是临床上最为常见、严重的肺外结核，具有较高的致死率高和致残率。结核性脑膜炎多起病隐匿，病程较慢，但也有部分患者起病较急，早期临床表现较轻，但随着颅内压的增高，患者常常表现出严重的脑膜刺激症状和颅内压增高表现，如头痛、呕吐和视乳头水肿，严重时出现去脑强直发作或去皮质状态，因此早期诊断并给予及时治疗尤为重要。目前结核性脑膜炎的诊断主要根据患者是否有其他部位的结核病史或结核接触史、具有典型的临床症状及体征、实验室检查。但是也有部分患者并无结核病史或结核接触史，且没有典型的临床表现，因此，早期诊断仅依赖于实验室检查。……