关键词: 结核, 脑膜, 聚合酶链反应, 脑脊髓液, 预后

Abstract: Objective  To explore the roles of FQ-PCR in rapid diagnosis，efficacy evaluation and prognosis for children tuberculous meningitis（TBM）. Methods  A total of 147 patients of children were enrolled in the study, 117 of whom were confirmed in prodromal stage TBM by the gold standard(culture with MGIT ^TM 960) and the others(n=30) were control group without TBM. Cerebrospinal fluid（CSF）specimens of 147 cases were immediately numbered and detected by FQ-PCR and then the sensitivity(SE), specificity(SP), diagnostic index(DI), positive predictive value(PPV), negative predictive value(NPV), agreement rate(AR) and other statistical indicators were calculate and analyzed. CSF of TBM group were cultured blindly and detected by FQ-PCR after 3 weeks and the two detection rate were calculated. Patients discharged from hospital who presented with negative by the two methods in the TBM group were followed up for 2 years and the recurrence rate was calculated.  Results  Compared to the gold standard, the SE，SP，DI and AR of FQ-PCR was 100.0%(117/117), 96.7%(29/30), 196.7%(116/117), and 99.3%, respectively(χ²=0.000, P=1.000). There was a correlation between the two methods(r=0.9790, χ²=140.9, P=0.000). Thirty-two cases and 68 cases of the TBM group were detected by culture method and FQ-PCR after treatment for 3 weeks, respectively(χ²=22.63, P=0.000). The follow-up results showed that 7 cases of 78 patients with negative culture result relapsed, 69 patients with negative FQ-PCR had no recurrence,（χ²=4.6736, P=0.0306）.  Conclusion  FQ-PCR detection of cerebrospinal fluid TB-DNA is accurate, simple, rapid method, which can be used for early diagnosis of tuberculous meningitis, but also has advantages of prognosis monitoring and efficacy evaluation than the culture method.

Key words: Tuberculosis,meningeal, Polymerase chain reaction, Cerebrospinal fluid, Prognosis