| Objective:Tuberculous meningitis(TBM),a chronic central nervous system infection disease caused by Mycobacterium tuberculosis. Because of the multiformity of clinical manifestations, TBM is always led to clinical misdiagnosis.at present, The diagnosis of tuberculous meningitis based on clinical manifestations, cerebrospinal fluid routine examination,biochemical examination,CSF Cytology and mycobacterial antigen in monocytes (macrophages). Through the methods, the sensitivity of the diagnosis of TBM was 82.9%, the specificity was 92.6%. However, with the different clinical manifestations, different types of cerebrospinal fluid cytology and the different prognosis, We infer that they have associated with the pathogenic mechanisms of pathogens and the immune status. In this study, by measuring the levels of Soluble interleukin-2 receptor and matrix metalloproteinase 9 in cerebrospinal fluid and observing the dynamic content ,in order to explore the pathogenesis of tuberculous meningitis and provide the basis for immunotherapy in the future.Methods:CSF samples were collected from 95 patients with definite diagnosis. All these patients were from the Second Hospital of Hebei Medical University during the period of 2007October~2008 September. These patients were divided into two groups.1.TBM group(research group): Totally 39 patients. Among them 22 patients were pure TBM, 8 patients have a history of exposure to tuberculosis, 7 patients combined Pulmonary tuberculosis, 1 patient combined spleen tuberculosis and 1 patient combined teseicular tuberculosis. Select 30 cases from them as measuring sIL-2R and MMP-9.2.The control group for mensuring Soluble interleukin-2 receptor : 6 patients with benign intracranial hypertension; 2 patients with hypertensive encephalopathy; 3 patients with vertebrobasilar insufficiency; 6 patients with cerebral thrombosis ; 3 patients with intracranial hypotension; 2 patients with nervous headache; 2 patients with the syndrome of cauda equina ; 2 patients with wernicke encephalopathy.3.The control group for mensuring matrix metalloproteinase 9: one is 14 patients with Non-neoplastic non-infectious headache,the other is 16 patients with viral meningitis.CSF was collected by lumbar puncture in all patients, and analyzed within 12 hours~48 hours, routine,biochemical, cytology (MGG dye, Indian ink and aricine blue staining), demonstration of mycobacterial antigen in monocytes (macrophages) are carried out at the same time in the group of TBM.and apply the ABC-ELISA method to measure the level of Soluble interleukin-2 receptor and matrix metalloproteinase 9. Results:1 The TBM group of CSF routine and biochemical test was 39of abnormal, and the rate of abnormality was 100%; A total of 29cases in TBM group show a mixed-cell response in CSF Cytology (73.6%);but Control group, lack of specificity of change. At the dynamic observation, patients in TBM group show polymorphonuclear dominant mixed-cell response before anti-tuberculosis treatment, while neutrophil gradually reduced after 2~3weeks treatment,the monocyte and lymphoid cells increased at the same time,but a mixed-cell response would last a long time . A total of 32cases in TBM group show a positive demostration of mycobacterial antigens in monocytes (82.9%). Compared the positive rate of≤14 days,15～30days,>30days, we consider that the highest positive of the demostration of antigens in monocytes within one month.So the demostration of antigens in monocytes is suitable for the early diagnosis.2 The levels of Soluble interleukin-2 receptor:Compare the Soluble interleukin-2 receptor levels in cerebrospinal fluid in case group (3.77±0.56 ng/ml) and control group(3.27±0.38ng/ml),there was a statistical significance. Compare the Soluble interleukin-2 receptor levels in cerebrospinal fluid before treatment(3.77±0.58ng/ml)and after treatment (3.40±0.76ng/ml) , there was a statistical significance. Compare the Soluble interleukin-2 receptor levels in cerebrospinal fluid in mixed-cell response(3.95±0.63ng / ml)and in lymphoidcells dominant response(3.61±0.60ng/ml), there was a statistical significance. Compare the Soluble interleukin-2 receptor levels in cerebrospinal fluid of consciousness(3.59±0.47ng/ml)and no consciousness(3.89±0.60ng/ml), it didn't have significant difference.3 The levels of matrix metalloproteinase 9: Compare the matrix metalloproteinase 9levels in cerebrospinal fluid in case group (6.24±1.55ng/ml) and control group 1(4.44±1.00ng/ml),there was a statistical significance;but with control group 2 (5.59±1.39ng / ml), it didn't have significant difference.between control group 1 and 2, there was a statistical significance.Compare the matrix metalloproteinase 9 levels in cerebrospinal fluid before treatment(6.24±1.55ng / ml)and after treatment (4.73±1.28ng/ml) , there was a statistical significance. Compare the matrix metalloproteinase 9 levels in cerebrospinal fluid in mixed-cell response(6.05±1.61ng /ml)and in lymphoidcells dominant response(4.85±1.21ng/ml), there was a statistical significance. Compare the matrix metalloproteinase 9 levels in cerebrospinal fluid of consciousness(7.31±1.23ngml)andnoconsciousness(5.51±1.33ng/ml), there was a statistical significance.Conclusions:1 Making use of CSF routine examination,biochemical examination,cerebrospinal fluid cytology and the detection of mycobacterial antigen in monocytes (macrophages) for the clinical diagnosis of patients with tuberculous meningitis. 2 By measuring the Soluble interleukin-2 receptor in cerebrospinal fluid prompts the body infected by Mycobacterium tuberculosis mainly start the T cell-mediated immunity, and the body in a state of disordered immune regulation. Through dynamic observing the changes has the significance of disease monitoring and assessment of prognosis in patients with tuberculous meningitis.3 By measuring the matrix metalloproteinase 9 in cerebrospinal fluid prompts the body infected by Mycobacterium tuberculosis through its certain components of cells stimulating the monocyte macrophages over-expression of MMP-9 and making damages to the blood-brain barrier,accordingly result in the disease.4 Through the determination of Soluble interleukin-2 receptor and matrix metalloproteinase 9 in cerebrospinal fluid, furtherly help us to understand the cellular immune mechanisms of patients with tuberculous meningitis and the pathogenesis of Mycobacterium tuberculosis.
|
PDF Full Text Request