关键词: 结核,脑膜, 脑脊髓液, 生物化学, 腺苷脱氨酶, 数据说明,统计, 结果评价(卫生保健)

Abstract:

Objective To investigate the biochemical test results of cerebrospinal fluid (CSF) in patients with tuberculous meningitis (TBM) and their dynamic changes, and to explore its clinical significance for the diagnosis of the patients’ condition. Methods A total of 46 patients with definite or suspected TBM (Thwaites diagnostic criteria) who were admitted to the Department of Neurology, Chest Hospital of Hebei Province from January 2011 to September 2014, were enrolled in this study. CSF biochemical markers(chloride, protein, glucose, adenosine deaminase (ADA)), severity grading (Stage Ⅰ, Ⅱ and Ⅲ, according to the Staging Standards of the British Medical Research Council (MRC))were recorded for correlation analysis. In addition, the dynamic changes of CFS biochemical markers and their clinical significance during the treatment were explored. Results CSF ADA level (M(Q₁,Q₃)) alone was significantly increased with the increase of MRC stage, which was 2.00 (1.00, 5.50) U/L in stage Ⅰ, 3.00 (2.00, 5.75) U/L in stage Ⅱ, and 7.50 (4.33, 10.00) U/L in stage Ⅲ (H=6.695, P=0.035). After pairwise comparisons between different stages, the CSF ADA and chloride levels (102.70 (98.10, 115.45) mmol/L) in patients with stage Ⅲ were significantly higher than those with stage Ⅰ (chloride 118.00 (111.80, 122.60) mmol/L) (U=13.609, P=0.033; U=2.122, P=0.035). CSF biochemical markers in 46 patients were gradually attenuated after standard treatment. The CSF chlorides were 118.10 (110.30, 121.55), 120.00 (115.93, 122.55), and 121.95 (117.78, 125.90) mmol/L at 1, 2, and 4 weeks after treatment, respectively. The levels of glucose were 2.48 (2.11, 2.91), 2.79 (2.31, 3.35), and 3.03 (2.49, 3.43) mmol/L, respectively, which were significantly higher than those on admission (114.75 (103.05, 118.55), 2.14 (1.67, 2.99) mmol/L), respectively (χ ²=34.103, 27.642; all P<0.01). In addition, at 1, 2, and 4 weeks after treatment, the levels of proteins were 0.62 (0.34, 0.93), 0.48 (0.26, 0.85), and 0.47 (0.27, 0.80) g/L, respectively and those of ADA were 2.50 (1.00, 5.25), 2.00 (1.00, 4.00), and 1.00 (1.00, 2.00) U/L, respectively, which were significantly lower than those on admission (0.95 (0.56, 1.34) g/L, and 3.50 (2.00, 7.25) U/L) (χ ²=29.221, 26.209; all P<0.01). In terms of the treatment process, as compared with the indicators on admission, there was no significant change in various indicators at 1 week after treatment (t=0.609, 0.565, 0.228, 0.359; all P>0.05). After 2 weeks after treatment, the indicators began to change remarkably (t=1.076, 1.239, 0.946, 0.761; all P<0.05). At 4 weeks after treatment, the indicators were also significantly higher than those on admission (t=1.489, 1.152, 1.261, 1.228; all P<0.01), whereas no significant difference were found in chloride, protein, glucose and ADA levels at the 2nd week after treatment (t=0.413, 0.087, 0.315, and 0.467, respectively; all P>0.05). Compared with the indicators at 1 week after treatment, the glucose and chloride levels at 4 weeks after treatment were significantly increased (t=1.033, P=0.001; t=0.880, P=0.006, respectively), and the level of ADA was significantly reduced (t=0.870, P=0.007), while there was no significant difference in the level of protein (t=0.587, P=0.175). Conclusion CSF ADA level is related to the severity of the disease. Therefore, dynamic measurement of CSF biochemical markers is helpful to evaluate the changes of TBM in patients.

Key words: Tuberculosis,meningeal, Cerebrospinal fluid, Biochemistry, Adenosine deaminase, Data interpretation,statistical, Outcome assessment (health care)