中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (7): 735-740.doi: 10.3969/j.issn.1000-6621.2021.07.016
收稿日期:
2021-03-11
出版日期:
2021-07-10
发布日期:
2021-07-09
通信作者:
王乐乐,杨松,唐神结
E-mail:yangsong5@aliyun.com;tangsj1106@vip.sina.com
基金资助:
WANG Le-le*, GUO Jian-qiong, YANG Song(), TANG Shen-jie(
)
Received:
2021-03-11
Online:
2021-07-10
Published:
2021-07-09
Contact:
WANG Le-le,YANG Song,TANG Shen-jie
E-mail:yangsong5@aliyun.com;tangsj1106@vip.sina.com
摘要:
结核性脑膜炎(tuberculous meningitis,TBM)是最常见的中枢神经系统结核病类型,也是最严重的肺外结核,常以非特异性症状起病。目前,所有的TBM诊断技术均不完美,虽患者脑脊液(cerebrospinal fluid,CSF)指标变化明显,但不具有特异性;加之CSF中的细菌载量非常低,相关实验室检测技术诊断敏感度低、耗时长。笔者通过总结目前TBM诊断中存在的问题,对TBM的不同诊断方法的最新研究进展和利弊进行综述,为进一步提高TBM患者确诊率,避免患者治疗时机的延误提供参考。
王乐乐, 郭建琼, 杨松, 唐神结. 结核性脑膜炎诊断方法研究进展[J]. 中国防痨杂志, 2021, 43(7): 735-740. doi: 10.3969/j.issn.1000-6621.2021.07.016
WANG Le-le, GUO Jian-qiong, YANG Song, TANG Shen-jie. Research progress on diagnosis methods of tuberculous meningitis[J]. Chinese Journal of Antituberculosis, 2021, 43(7): 735-740. doi: 10.3969/j.issn.1000-6621.2021.07.016
[1] |
Arshad A, Dayal S, Gadhe R, et al. Analysis of tuberculosis meningitis pathogenesis, diagnosis, and treatment. J Clin Med, 2020, 9(9):2962. doi: 10.3390/jcm9092962.
doi: 10.3390/jcm9092962 URL |
[2] |
Foppiano Palacios C, Saleeb PG. Challenges in the diagnosis of tuberculous meningitis. J Clin Tuberc Other Mycobact Dis, 2020, 20:100164. doi: 10.1016/j.jctube.2020.100164.
doi: 10.1016/j.jctube.2020.100164 pmid: 32462082 |
[3] |
Kang W, Yu J, Du J, et al. The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study. PLoS One, 2020, 15(8):e0237753. doi: 10.1371/journal.pone.0237753.
doi: 10.1371/journal.pone.0237753 URL |
[4] |
中华医学会结核病学分会结核性脑膜炎专业委员会. 2019中国中枢神经系统结核病诊疗指南. 中华传染病杂志, 2020, 38(7):400-408. doi: 10.3760/cma.j.cn.311365-20200606-00645.
doi: 10.3760/cma.j.cn.311365-20200606-00645 |
[5] |
Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol, 2013, 12(10):999-1010. doi: 10.1016/S1474-4422(13)70168-6.
doi: 10.1016/S1474-4422(13)70168-6 pmid: 23972913 |
[6] |
Pormohammad A, Nasiri MJ, McHugh TD, et al. A syste-matic review and meta-analysis of the diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis. J Clin Microbiol, 2019, 57(6):1-16. doi: 10.1128/JCM.01113-18.
doi: 10.1128/JCM.01113-18 |
[7] |
Donovan J, Thwaites GE, Huynh J. Tuberculous meningitis: where to from here? Curr Opin Infect Dis, 2020, 33(3):259-266. doi: 10.1097/QCO.0000000000000648.
doi: 10.1097/QCO.0000000000000648 pmid: 32324614 |
[8] |
Boyles TH, Lynen L, Seddon JA, et al. Decision-making in the diagnosis of tuberculous meningitis. Wellcome Open Res, 2020, 5:11. doi: 10.12688/wellcomeopenres.15611.1.
doi: 10.12688/wellcomeopenres.15611.1 pmid: 32964134 |
[9] |
Seddon JA, Tugume L, Solomons R, et al. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res, 2019, 4:167. doi: 10.12688/wellcomeopenres.15535.1.
doi: 10.12688/wellcomeopenres.15535.1 pmid: 32118118 |
[10] |
葛向华, 李保胜, 刘芳, 等. 不典型结核性脑膜炎三例误诊原因分析. 临床误诊误治, 2021, 34(2):11-14. doi: 10.3969/j.issn.1002-3429.2021.02.004.
doi: 10.3969/j.issn.1002-3429.2021.02.004 |
[11] |
Bahr NC, Boulware DR. Methods of rapid diagnosis for the etiology of meningitis in adults. Biomark Med, 2014, 8(9):1085-1103. doi: 10.2217/bmm.14.67.
doi: 10.2217/bmm.14.67 URL |
[12] |
Bahr NC, Tugume L, Rajasingham R, et al. Improved diagnostic sensitivity for tuberculous meningitis with Xpert®MTB/RIF of centrifuged CSF. Int J Tuberc Lung Dis, 2015, 19(10):1209-1215. doi: 10.5588/ijtld.15.0253.
doi: 10.5588/ijtld.15.0253 URL |
[13] |
Bahr NC, Nuwagira E, Evans EE, et al. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: aprospectivecohort study. Lancet Infect Dis, 2018, 18(1):68-75. doi: 10.1016/S1473-3099(17)30474-7.
doi: 10.1016/S1473-3099(17)30474-7 URL |
[14] |
Nhu NT, Heemskerk D, Thu do DA, et al. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis. J Clin Microbiol, 2014, 52(1):226-233. doi: 10.1128/JCM.01834-13.
doi: 10.1128/JCM.01834-13 URL |
[15] |
Poplin V, Boulware DR, Bahr NC. Methods for rapid diagnosis of meningitis etiology in adults. Biomark Med, 2020, 14(6):459-479. doi: 10.2217/bmm-2019-0333.
doi: 10.2217/bmm-2019-0333 |
[16] |
Tetsuka S, Suzuki T, Ogawa T, et al. Central nervous system tuberculoma with miliary tuberculosis in the elderly. IDCases, 2020, 19:e00710. doi: 10.1016/j.idcr.2020.e00710.
doi: 10.1016/j.idcr.2020.e00710 URL |
[17] |
Seddon JA, Thwaites GE. Tuberculous meningitis: new tools and new approaches required. Wellcome Open Res, 2019, 4:181. doi: 10.12688/wellcomeopenres.15591.1.
doi: 10.12688/wellcomeopenres.15591.1 pmid: 31803849 |
[18] |
冉燕, 赵建军, 张建勇, 等. 利福平耐药实时荧光定量核酸扩增检测技术及环介导等温扩增技术在结核性脑膜炎的诊断价值. 实用医学杂志, 2020, 36(24):3416-3419. doi: 10.3969/j.issn.1006-5725.2020.24.022.
doi: 10.3969/j.issn.1006-5725.2020.24.022 |
[19] |
Chan TCH, Chen SPL, Mak CM, et al. Determination of cerebrospinal fluid adenosine deaminase activity cut-off for the diagnosis of tuberculous meningitis in Hong Kong. J Clin Pathol, 2020, 73(12):800-802. doi: 10.1136/jclinpath-2019-206397.
doi: 10.1136/jclinpath-2019-206397 URL |
[20] |
Krishnakumariamma K, Ellappan K, Muthuraj M, et al. Molecular diagnosis, genetic diversity and drug sensitivity patterns of Mycobacterium tuberculosis strains isolated from tuberculous meningitis patients at a tertiary care hospital in South India. PLoS One, 2020, 15(10):e0240257. doi: 10.1371/journal.pone.0240257.
doi: 10.1371/journal.pone.0240257 URL |
[21] |
Chen Y, Liu X, Zhang X, et al. Longitudinal cerebrospinal fluid assessment in a patient with tuberculous meningitis-a case report. J Clin Lab Anal, 2020, 34(7):e23286. doi: 10.1002/jcla.23286.
doi: 10.1002/jcla.23286 |
[22] |
Feng GD, Shi M, Ma L, et al. Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. Am J Respir Crit Care Med, 2014, 189(4):475-481. doi: 10.1164/rccm.201309-1686OC.
doi: 10.1164/rccm.201309-1686OC URL |
[23] |
Heemskerk AD, Donovan J, Thu DDA, et al. Improving the microbiological diagnosis of tuberculous meningitis: A prospective, international, multicentre comparison of conventional and modified Ziehl-Neelsen stain, GeneXpert, and culture of cerebrospinal fluid. J Infect, 2018, 77(6):509-515. doi: 10.1016/j.jinf.2018.09.003.
doi: 10.1016/j.jinf.2018.09.003 URL |
[24] |
李雪莲, 马丽萍, 陈红梅, 等. 脑脊液中腺苷脱氨酶水平对结核性脑膜炎的诊断价值. 中华结核和呼吸杂志, 2017, 40(5):339-342. doi: 10.3760/cma.j.issn.1001-0939.2017.05.005.
doi: 10.3760/cma.j.issn.1001-0939.2017.05.005 |
[25] |
陈颜强, 赵立明, 李薇, 等. 结核性脑膜炎患者行脑脊液腺苷脱氨酶及其他生化项目检测的临床意义. 中国防痨杂志, 2019, 41(7):754-758. doi: 10.3969/j.issn.1000-6621.2019.07.010.
doi: 10.3969/j.issn.1000-6621.2019.07.010 |
[26] | 史君华, 范惠先, 郜晓飞, 等. 结核性脑膜炎患者脑脊液腺苷脱氨酶水平动态变化及其诊断价值. 天津医科大学学报, 2018, 24(3):249-251. |
[27] |
张新宝, 姚超, 洪青青, 等. T细胞斑点试验在结核性脑膜炎诊断中的应用价值. 中国感染与化疗杂志, 2021, 21(1):32-36. doi: 10.16718/j.1009-7708.2021.01.005.
doi: 10.16718/j.1009-7708.2021.01.005 |
[28] |
杨清銮, 张冰琰, 刘倩倩, 等. 外周血及脑脊液结核感染T淋巴细胞斑点试验对结核性脑膜炎的诊断价值. 中华传染病杂志, 2018, 36(10):622-626. doi: 10.3760/cma.j.issn.1000-6680.2018.10.009.
doi: 10.3760/cma.j.issn.1000-6680.2018.10.009 |
[29] |
王鑫, 买尔旦·阿不来. 结核感染T细胞斑点试验与脑脊液细胞学快速诊断结核性脑膜炎的临床价值. 中国临床研究, 2019, 32(7):931-934. doi: 10.13429/j.cnki.cjcr.2019.07.016.
doi: 10.13429/j.cnki.cjcr.2019.07.016 |
[30] |
陈宇, 姚素艳. 利福平耐药实时荧光定量核酸扩增技术联合结核感染T淋巴细胞酶联免疫斑点试验诊断结核性脑膜炎的价值. 中国医师进修杂志, 2021, 44(3):264-268. doi: 10.3760/cma.j.cn115455-20200319-00330.
doi: 10.3760/cma.j.cn115455-20200319-00330 |
[31] |
Li Z, Pan L, Lyu L, et al. Diagnostic accuracy of droplet digital PCR analysis of cerebrospinal fluid for tuberculous meningitis in adult patients. Clin Microbiol Infect, 2020, 26(2):213-219. doi: 10.1016/j.cmi.2019.07.015.
doi: 10.1016/j.cmi.2019.07.015 URL |
[32] |
Kay AW, Fern$\acute{a}$ndez LG, Takwoingi Y, et al. Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children. Cochrane Database Syst Rev, 2020, 8: CD013359. doi: 10.1002/14651858.CD013359.pub2.
doi: 10.1002/14651858.CD013359.pub2 |
[33] |
Bhasin H, Goyal M, Sharma S. Advances in the diagnosis and management of tubercular meningitis in children. Indian J Pediatr, 2020, 87(1):26-33. doi: 10.1007/s12098-019-03089-x.
doi: 10.1007/s12098-019-03089-x URL |
[34] |
Donovan J, Thu DDA, Phu NH, et al. Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study. Lancet Infect Dis, 2020, 20(3):299-307. doi: 10.1016/S1473-3099(19)30649-8.
doi: S1473-3099(19)30649-8 pmid: 31924551 |
[35] | World Health Organization. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB/RIF Ultra compared to Xpert MTB/RIF. Geneva: World Health Organization, 2017. |
[36] |
Huang ML, Wang GR, Sun Q, et al. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in a clinical practice setting of China. Diagn Microbiol Infect Dis, 2021, 100(1):115306. doi: 10.1016/j.diagmicrobio.2020.115306.
doi: 10.1016/j.diagmicrobio.2020.115306 URL |
[37] |
Siddiqi OK, Birbeck GL, Ghebremichael M, et al. Prospective Cohort Study on Performance of Cerebrospinal Fluid (CSF) Xpert MTB/RIF, CSF Lipoarabinomannan (LAM) Lateral Flow Assay (LFA), and Urine LAM LFA for Diagnosis of Tuberculous Meningitis in Zambia. J Clin Microbiol, 2019, 57(8):e00652-19. doi: 10.1128/JCM.00652-19.
doi: 10.1128/JCM.00652-19 |
[38] |
Quinn CM, Kagimu E, Okirworth M, et al. Fujifilm SILVAMP TB LAM assay on cerebrospinal fluid for the detection of tuberculous meningitis in HIV-infected adults. Clin Infect Dis, 2021: ciaa1910. doi: 10.1093/cid/ciaa1910.
doi: 10.1093/cid/ciaa1910 |
[39] |
Donovan J, Cresswell FV, Thuong NTT, et al. Xpert MTB/RIF Ultra for the Diagnosis of Tuberculous Meningitis: A Small Step Forward. Clin Infect Dis, 2020, 71(8):2002-2005. doi: 10.1093/cid/ciaa473.
doi: 10.1093/cid/ciaa473 URL |
[40] |
钱乔乔, 刘婷, 孙丹, 等. 脑脊液二代测序对5例结核性脑膜炎患儿精准诊断价值研究. 中国实用儿科杂志, 2021, 36(1):53-56. doi: 10.19538/j.ek2021010612.
doi: 10.19538/j.ek2021010612 |
[41] |
林爱清, 张璐, 成宝涛, 等. 二代测序技术应用于脑脊液检测在结核性脑膜炎中的早期诊断价值. 中华实验和临床感染病杂志(电子版), 2020, 14(4):291-295. doi: 10.3877/cma.j.issn.1674-1358. 2020. 04. 005.
doi: 10.3877/cma.j.issn.1674-1358. 2020. 04. 005 |
[42] |
Yu G, Zhao W, Shen Y, et al. Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis. PLoS One, 2020, 15(12):e0243161. doi: 10.1371/journal.pone.0243161.
doi: 10.1371/journal.pone.0243161 URL |
[43] |
Ajbani K, Kazi M, Agrawal U, et al. Evaluation of CSF pyrosequencing to diagnose tuberculous meningitis: A retrospective diagnostic accuracy study. Tuberculosis (Edinb), 2021, 126:102048. doi: 10.1016/j.tube.2020.102048.
doi: 10.1016/j.tube.2020.102048 URL |
[44] |
Salvador GLO, Basso ACN, Barbieri PP, et al. Central ner-vous system and spinal cord tuberculosis: Revisiting an important disease. Clin Imaging, 2021, 69:158-168. doi: 10.1016/j.clinimag.2020.07.020.
doi: 10.1016/j.clinimag.2020.07.020 URL |
[45] |
李雪莲, 李洁, 陈红梅, 等. 结核性脑膜炎并发颅神经损伤的临床特征分析. 中国防痨杂志, 2019, 41(1):24-30. doi: 10.3969/j.issn.1000-6621.2019.01.007.
doi: 10.3969/j.issn.1000-6621.2019.01.007 |
[46] |
许国宇, 李红, 敖国昆, 等. 磁共振成像对结核性脑膜炎伴发脑梗死的诊断价值. 中华临床医师杂志(电子版), 2011, 5(20):5939-5944. doi: 10.3877/cma.j.issn.1674-0785.2011.20.017.
doi: 10.3877/cma.j.issn.1674-0785.2011.20.017 |
[47] |
Kalita J, Prasad S, Maurya PK, et al. MR angiography in tuberculous meningitis. Acta Radiol, 2012, 53(3):324-329. doi: 10.1258/ar.2012.110712.
doi: 10.1258/ar.2012.110712 URL |
[48] |
Sharifi G, Mousavinejad SA, Moradian K, et al. Pineal Region Tuberculoma Caused by Mycobacterium bovis as a Complication of Bacille Calmette-Guérin Vaccine: Case Report and Review of the Literature. World Neurosurg, 2020, 133:416-418. doi: 10.1016/j.wneu.2019.04.008.
doi: S1878-8750(19)30999-4 pmid: 31181358 |
[49] |
Sharma MC, Arora R, Mahapatra AK, et al. Intrasellar tuberculoma-an enigmatic pituitary infection: a series of 18 cases. Clin Neurol Neurosurg, 2000, 102(2):72-77. doi: 10.1016/s0303-8467(00)00063-9.
doi: 10.1016/s0303-8467(00)00063-9 URL |
[50] |
韩小妍, 梁玉婵, 郭晓珍, 等. 病毒性脑炎和结核性脑膜炎的临床诊断鉴别分析. 临床医学工程, 2019, 26(7):973-974. doi: 10.3969/j.issn.1674-4659.2019.07.0973.
doi: 10.3969/j.issn.1674-4659.2019.07.0973 |
[51] |
Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 2010, 10(11):803-812. doi: 10.1016/S1473-3099(10)70138-9.
doi: 10.1016/S1473-3099(10)70138-9 URL |
[52] |
Cresswell FV, Bangdiwala AS, Meya DB, et al. Absence of cerebrospinal fluid pleocytosis in tuberculous meningitis is a common occurrence in HIV co-infection and a predictor of poor outcomes. Int J Infect Dis, 2018, 68:77-78. doi: 10.1016/j.ijid.2018.01.014.
doi: S1201-9712(18)30015-8 pmid: 29391245 |
[53] | World Health Organization. Update on the use of nucleic acid amplification tests to detect TB and drug-resistant TB: rapid communication. Geneva:World Health Organization, 2021. |
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[14] | 郑璐瑶, 陆宇, 陈效友. 非结核分枝杆菌肺病治疗药物研发的现状与挑战[J]. 中国防痨杂志, 2021, 43(7): 729-734. |
[15] | 魏倩, 王仕昌, 曹传兵. 2020年山东省公众结核病防治核心信息知晓率调查结果分析[J]. 中国防痨杂志, 2021, 43(7): 741-746. |
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