| Tuberculosis (TB) is a cosmopolitan problem of public health. The polyinfection of HIV, multidrug resistant tubercle bacillus and the move of population lead to the rise of attack rate and mortality. Tuberculous meningitis (TBM) with a high disability rate, is the most devastating form of tuberculosis. The early diagnosis is difficult, and tuberculous meningitis is the most important reason to the death of the tuberculou patients. And there is strong relationship between the prognosis and the opportunity of diagnosis and treatment. Because the clinical manifestation of TBM in earlier period is not specific, it is difficult to distinguish the TBM with viral meningitis, purulent meningitis and cryptococcal meningitis. It is essential to find a indicate for us to diagnose TBM in the forepart of diseases.The traditional laboratory diagnostic method of tuberculous meningitis are bacterial smear and culture of cerebrospinal fluid, cerebrospinal fluid biochemistry, antibody detection,and so on. The bacterial cerebrospinal fluid smears and culture is a golden index for TBM. But it is regrettable that the sensitivity and specificity of that these traditional laboratory testing method is not yet satisfactory.ELISPOT technology is a sophisticated immunological detection technology. It combines cell culture technology and enzyme-linked immunosorbent assay technique (ELISA technology), with a series of advantages: high sensitivity, in the single-cell level in the secretion of cytokines, can detect live immune cells function and status, and the operation is simple. Now ELISPOT assay detection of specific lymphocytes screening in patients with tuberculosis, has been used in the United Kingdom and the United States for TB diagnosis.ELISPOT assays were used to measure the frequency of peripheral blood T cells producing IFN-γin response to PPD, It is a very effective TB diagnostic method. But few study on the cerebrospinal fluid (CSF) and TBM.Objective:To measure the frequency of CSF cells producing IFN-γin response to PPD by ELISPOT assay,and evalue the clinical value for the diagnosis of TBM in earlier period.Methods:Patients: During 2007.3-2007.12, to select 30 TBM patients within 14 days after TBM onset, from TBM study and treatment centre of Changchun city and the first hospital of Jilin university,and 30 patients with other infectious diseases of the CNS (control team) from the first hospital of Jilin university.To get about 4-6ml CSF from each TBM and controllers, then remove some plasma for ELISA assay for detecting the anti-TB antibody and extract the mononuclear cells (MNCs) for PPD- ELISPOT assay for detecting cells producing IFN-γin CSF.At last,to compare the result of ELISPOT assay with the result of ELISA assay.Result: 1. PPD-ELISPOT assay detecting cells producing IFN-γin CSF: In the 30 TBM patients, 25 patients were positive and 5 patients were negative, 83.3% made IFN-γin response to PPD. And in the 30 patients with other infectious diseases of the CNS, no patient was positive.2. ELISA assay detecting the anti-TB antibody: In the 30 TBM patients,5 patients were positive and 25 patients were negative,and the 5 positive patients made IFN-γin response to PPD in ELISPOT assay. But in the 30 patients with other infectious diseases of the CNS, 0 was positive.The PPD-ELISPOT assay detecting CSF cells producing IFN-γwas more sensitive than the ELISA assay detecting the anti-TB antibody.Conclusion:The PPD-ELISPOT assay detecting CSF cells producing IFN-γwas a effective auxiliary examination to the diagnosis of early TBM... |
PDF Full Text Request