The Disscussion Of Heparin-binding Hemagglutinin Adhesin And Insulin-like Growth Faetor In The Pathogenesis Of Tuberculous Meningitis

Objective: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis. When immunity of the organism is high, blood brain barrier can prevents bacteria and other pathogens of infection, have protection of the brain function,When immunity of the organism is low, Tuberculous meningitis can crossing the blood-brain barrier into subarachnoid cause inflammation. Heparin-binding hemagglutinin adhesin (HBHA) is a glycoprotein, The C-terminal lysine-rich domain of the protein can Binding to the epithelial cells of sulfuric acid acetyl heparin receptors.and hope tuberculosis mycobacteria crossing the blood-brain barrier. Insulin growth factor -Ⅱ(IGF - 2) is mainly insulin-like growth factor in the brain, is the main source of insulin growth factor, can promote the use of glucose in the brain tissue, generally considered when Tuberculous meningitis infection, glucose which in cerebrospinal fluid reduce with this factor has a relationship. In this study, by measuring the levels of Heparin-binding hemagglutinin adhesin (HBHA) and Insulin growth factor -Ⅱ(IGF - 2) in cerebrospinal fluid and observing the dynamic content,in order to explore the pathogenesis of tuberculous meningitis and provide the basis for immunotherapy and anti-inflammatory treatment in the future.Methods: All these patients were from the Second Hospital of Hebei Medical University during the period of 2009 December~2010 October.1 tuberculous meningitis: 30 cases are diagnosed as tuberculous meningitis, including 4 of highly probable tuberculous meningitis,18 of probable tuberculous meningitis and 8of possible tuberculous meningitis.2 The control group: 30 cases including 9 patient with Gearan barre, 9 patient withhemopathy, 3 patient with cephalalgia, 3 patient with Peripheral neuropathy, 3 patient with Brain cysticercosis, 2patient with 1 diopathic epil- epsy and 1 patient with Multiple sclerosis.CSF was collected by lumbar puncture in all patients and were analyzed routine,biochemical (both express three tenors one low)and cytology (aricine blue staining and MGG dye). Apply the ABC-ELISA method to measure the level of HBHA and IGF-2.Results:1 CSF conventional test:Compare the wbc levels in cerebrospinal fluid in tuberculous meningitis (0～3496 mm~3) and control group (0～75 mm~3),there was a statistical significance.2 The levels of Heparin-binding hemagglutinin adhesin in CSF:Compare the Heparin-binding hemagglutinin adhesin levels in cerebrospinal fluid in tube- rculous meningitis (28.327～70.798) pg/ml and control group(28.040～31.397) pg/ ml,there was a statistical significance.Compare the level of Heparin-binding hemagglutinin adhesin in cerebrospinal fluid inⅠa ndⅡcases. The meningitis respectively are 28.23±7.01pg/ml and 30.61±1.79pg/ml, there was a statistical significance.3 The levels of insulin-like growth faetor in CSF:Compare the insulin-like growth faetor in cerebrospinal fluid in tuberculous meningitis (117.992～214.339) ng/ml and control group(117.594～155.33) ng/ml,there was a sta- tistical significance. Compare the level of insulin-like growth faetor in cerebrospinal fluid inⅠa ndⅡc ases. The meningitis respectively are 121.9±1.07ng/ml,127.43±4.68ng/ml, there was not a statistical significance.4 Compare the levels Heparin-binding hemagglutinin adhesin of cerebrospinal fluid in neutrophil cell dominant response and in lymphoid cells dominant response, there were not a statistical significance.5 The change of insulin-like growth faetor in cerebrospinal fluid is negative c- orrelation with the change of glucose levels in cerebrospinal fluid in tubercul- ous meningitis6 We observed dynamically the expression of HBHA,and found that the level of HBHA changed with the patient's condition and the protein of cerebrospinal fluid in the same direction.Conclusions:1 The level of HBHA in cerebrospinal fluid is rised in tuberculous meningitis. Detection of HBHA protein can support the diagnosis of tub- erculous meningitis.Through dynamic observing the changes has the very importent significance of disease monitoring in patients with tuberculous meningitis.2 The results show that the expression of IGF-2 increased in the cerebrospinal fluid of tuberculous menigitis. It indicated that IGF-2 par- ticipated in the pathogenesis of brain injury and neural protection process. The rise of IGF-2 and the reduce of sugar content did have some negative relation. In other words,the reduce of sugar in cerebrospinal fluid was related to the expression of IGF-2.