The Expression Of ESAT-6and CFP-10in The Cerebrospinal Fluid Of Patients With Tuberculous Meningitis

Objective: Tuberculous meningitis (TBM) is a non-suppurativeinflammatory diseases of meninges and spinal cord membrane caused byMycobacterium tuberculosis (MTB) infection the subarachnoid. TBM is aserious extrapulmonary tuberculosis, mortality and morbidity is high, rapidand effective diagnosis and early treatment is the key to reduce mortality andmorbidity. Early, accurate diagnosis of tuberculous meningitis has been aworldwide problem, to find evidence of MTB present in the subarachnoidspace is the key to the diagnosis of TBM, the use of immunological detectionof MTB-specific antigen in the cerebrospinal fluid can prove the existence ofMTB. Mycobacterium tuberculosis6kD early secretory antigenic target andculture filtrate of protein10, both of MTB specific antigen, tuberculousmeningitis diagnosis is the most promising antigens. In this study, ELISA andimmunohistochemistry are two ways to carry out quantitative and qualitativeanalysis and cellular localization in the cerebrospinal fluid of tuberculousmeningitis in patients with ESAT-6and CFP-10and provide the basis for theclinical diagnosis of TBM and laboratory research.Methods: Collection medical records of clinical suspicion of TBMpatients, score them according to the latest diagnostic criteria, screening out of30cases: the “Definite TBM” and “probable TBM” as the case group (TBMgroup),20cases of non-tuberculous meningitis patients (non-TBM group) forthe control group. TBM group of all patients take the lumbar punctureanti-tuberculosis treatment before and1to2weeks after, collect thecerebrospinal fluid. Analysis all the results of CSF routine and biochemistryexamination to TBM group and non-TBM group (80). By ELISA doubleantibody sandwich method were detected in cerebrospinal fluid of80ESAT-6and CFP-10antigens, to analyze the concentration of antibodies. Collected by centrifugation Results brain group and non-tuberculous meningitiscerebrospinal fluid cells in the slide, the two antigens in cerebrospinal fluidmononuclear cells detected by immunocytochemistry staining method, opticalmicroscope observation, the cytoplasm brown particle deposition is positive,colorless compared to negative, record and analyze the results.Results:1Clinical data analysis:30cases of TBM patients met inclusion criteria,the definite TBM5cases, probable TBM25cases, including16cases ofmales and14females, aged8months to60years, an average of34.39±2.76years old. For other neurological diseases, the control group, a total of20cases,12males and8females, aged from4to67years with an average of30.64±4.27years old. TBM compared with the control group, CSF pressure,the total number of cells, white blood cells, protein content were increased,glucose, chloride content decreased, the differences were statisticallysignificant (P <0.05). Before and after the treatment of TBM group CSFroutine biochemical analysis of CSF pressure, the total number of cells, whiteblood cell count, protein content were lower, the differences were statisticallysignificant (P <0.05), and glucose, chloride content differences were notstatistical significance (P>0.05).2ESAT-6antigen in CSF: The ESAT-6level in CSF of TBM group is(26.38-39.68) pg/ml， the average content is33.03±3.32pg/ml; ESAT-6levels in the control group is (0.00-1.47) pg/ml, the content of the average is0.05±0.87pg/ml, compared with0was not significant difference (P>0.05).Experimental group and control group were significantly different (P <0.05).CSF in patients with TBM before treatment ESAT-6level is (33.37-53.42)pg/ml, an average of43.40±4.90pg/ml;1to2weeks after treatment, thelevel is (15.14-30.18) pg/ml, an average of22.66±3.68pg/ml, the differencewas statistically significant (P <0.05).3CFP-10antigen in CSF: CFP-10level in the CSF of TBM group is(181.18-244.67) pg/ml, the average content of212.93±15.86pg/ml; controlgroup,(7.59~35.99) pg/ml in the average content of9.73±32.63pg/ml, too more significant difference (P <0.05). Before treatment, the CFP-10level is(204.61-300.68) pg/ml, the average252.64±23.49pg/ml, treatment for1to2weeks after the cerebrospinal fluid in the CFP-10levels (134.21-212.22)pg/ml, with an average value of173.21±19.07pg/ml before and afterdifference was statistically significant (P <0.05).4ESAT-6and CFP-10antigens in the cells of CSF:30cases of TBMgroup, take the first lumbar puncture and cerebrospinal fluid cell producer,22cases were positive by ESAT-6immunocytochemical staining in the controlgroup,2cases were positive, are eosinophils shader. The sensitivity of73.33%and a specificity of90.00%; the CFP-10immunocytochemical staining26cases were positive in the control group patients were positive, the sensitivitywas86.67%and a specificity of95.00%.5Combined detection the ESAT-6and CFP-10antigens To the4results:The sensitivity and specificity of the detection of two antigens, respectivelychi-square test, the sensitivity of P <0.05, the difference was statisticallysignificant; specific P>0.05, the difference was not statistically significant.Therefore, the sensitivity of united detection two antigens is higher thanetection any one.Conclusion: ESAT-6and CFP-10antigens are the specific antigen ofMTB, present in the CSF of patients with TBM, while non in the otherpatients. Early onset that can detect the antigen content with her conditionimproved and reduced to provide a basis to determine the condition for theearly diagnosis of TBM. To observe their content TBM condition of thepatient monitoring is important. Both antigens in CSF mononuclear cells,available Immunocytological method its diagnosis, the sensitivity andspecificity fit with previous reports. Joint detection of two antigens comparedwith more sensitive detection of single antigen.