樊丽超 陈宇 朱雅娟 曹宏丽

[摘要] 目的 分析和比較脑脊液环介导等温扩增（Loop-mediated isothermal amplification，LAMP）和GeneXpert MTB/RIF（简称GeneXpert）在结核性脑膜炎早期诊断中的效能。 方法 选取沈阳市胸科医院2018年6月～2019年6月疑诊结核性脑膜炎的患者189例，采集患者抗结核治疗前的脑脊液标本分别进行液体培养（MGIT）、LAMP和GeneXpert检测。以液体培养法（MGIT）为标准，计算2种检测技术在结核性脑膜炎诊断中的敏感度、特异度、阳性预测值、阴性预测值、一致率、Kappa值。 结果 LAMP的敏感度为79.6%，特异度为94.3%，阳性预测值为83.0%，阴性预测值93.0%，一致率90.5%，Kappa值=0.749。GeneXpert的敏感度为98.0%，特异度为88.6%，阳性预测值为75.0%，阴性预测值为99.2%，一致率为91.0%，Kappa值=0.787。 结论 LAMP和GeneXpert对结核性脑膜炎检测的灵敏度较液体培养（MGIT）明显提高，可以在一定程度上提高临床医生对疑似结核性脑膜炎患者的诊治能力，值得在基层结核病院实验室广泛推广。

[关键词] 结核性脑膜炎;脑脊液;环介导等温扩增

[中图分类号] R529.3          [文献标识码] B          [文章编号] 1673-9701（2020）17-0128-04

Effectiveness analysis of CSF loop-mediated isothermal amplification and GeneXpert MTB/RIF in the early diagnosis of tuberculous meningitis

FAN Lichao   CHEN Yu   ZHU Yajuan   CAO Hongli

Department of Tuberculosis， the Tenth People's Hospital of Shenyang（Shenyang Chest Hospital）， Shenyang   110044， China

[Abstract] Objective To analyze and compare the efficacy of cerebrospinal fluid loop-mediated isothermal amplification（LAMP） and GeneXpert MTB/RIF（GeneXpert） in the early diagnosis of tuberculous meningitis. Methods A total of 189 patients with suspected tuberculous meningitis from Shenyang Chest Hospital from June 2018 to June 2019 were selected. Cerebrospinal fluid samples from patients before antituberculosis treatment were collected for mycobacterium growth indicator tube（MGIT）， LAMP， and GeneXpert tests. Using the mycobacterium growth indicator tube（MGIT） as the standard， the sensitivity， specificity， positive predictive value， negative predictive value， agreement rate， and Kappa value of the two detection techniques in the diagnosis of tuberculous meningitis were calculated. Results The sensitivity of LAMP was 79.6%， the specificity was 94.3%， the positive predictive value was 83.0%， the negative predictive value was 93.0%， the agreement rate was 90.5%， and the Kappa value was 0.749. The sensitivity of GeneXpert was 98.0%， the specificity was 88.6%， the positive predictive value was 75.0%， the negative predictive value was 99.2%， the agreement rate was 91.0%， and the Kappa value of 0.787. Conclusion The LAMP and GeneXpert in the detection of tuberculous meningitis have significantly higher sensitivity than that of mycobacterium growth indicator tube（MGIT）， which can improve the diagnosis and treatment ability of clinicians to patients with suspected tuberculous meningitis. It is worthy of widespread promotion in the laboratory of primary tuberculosis hospital.

[Key words] Tuberculous meningitis; Cerebrospinal fluid; Loop-mediated isothermal amplification

结核性脑膜炎（tuberculous meningitis，TBM）是脑膜非化脓性炎症，多数由结核分枝杆菌经血液循环或直接途径侵入蛛网膜下间隙而引起，是结核病中最严重的类型之一，该病发病急缓不定，但病程都较长，致残率和死亡率高，故早期诊断和尽早合理规范的治疗，对改善患者的预后，降低后遗症的发病率至关重要[1]。

传统的TBM诊断金标准为脑脊液抗酸染色阳性或脑脊液结核菌培养阳性，但抗酸染色阳性率极低，结核菌培养耗时长，对TBM的早期诊断价值有限。环介导等温扩增（Loop-mediated isothermal amplification，LAMP）技术是可以检测结核分枝杆菌的一种新型的恒温核酸扩增技术，该方法操作简单，报告快速，不需要昂贵的仪器设备，比较适合在基层实验室推广应用[2]。……