中国防痨杂志2024，Vol.46Issue(3)：311-317,7.DOI:10.19982/j.issn.1000-6621.20230419
脑脊液特征指标辅助结核性脑膜炎快速筛查的效果评估
Evaluation of the effectiveness of cerebrospinal fluid characteristics indicators in assisting rapid screening of tuberculous meningitis
摘要
Abstract
Objective:To explore the apllication of several cerebrospinal fluid(CSF)indicators to improve the detection sensitivity and achieve rapid screening and early treatment control of tuberculous meningitis(TBM).Methods:From 2011 to 2019,according to the inclusion and exclusion criteria,100 TBM patients were randomly selected from 383 suspected TBM patients admitted to tuberculosis designated medical institutions in Suzhou of Jiangsu Province,Zigong of Sichuan Province and Guiyang of Guizhou Province.And 100 non-TBM patients were selected based on age and sex matched of 1∶1.The biochemical indicators such as white blood cell count,lactate,total protein,adenosine deaminase,and glucose in CSF were collected.Ultra high-throughput liquid chromatography was used to separate the metabolites of CSF.The metabolic indicators with statistically significant differences in distribution were screened by Orthogonal Projections to Latent Structures-Discriminant Analysis(OPLS-DA).A classification and regression tree(boosted-CART)model was constructed by machine learning.The effect of characteristic indicators on rapid screening of TBM patients with various types was evaluated.Results:Using the criteria of P＜0.05,OPLS-DA variable important in projection value＞1 and absolute value of Forld Change＞1,the above model was combined to screen CSF L-glutamine and glucose levels as characteristic indicators.The cutoff values were 607.06 mmol/L(L-glutamine)and 60.03 mg/dl(glucose),respectively.The combination of the above two indicators improved the sensitivity of detecting probable and possible TBM from 66.7％(95％CI:24.1％-94.0％)to 83.3％(95％CI:36.5％-99.1％),AUC increased from 0.667(95％CI:0.444-0.889)to 0.708(95％CI:0.494-0.923)(Z=0.261,P＞0.05).Conclusion:Biochemical and metabolic indicators such as CSF L-glutamine and glucose can improve the sensitivity of rapid TBM screening,which is conducive to the early diagnosis and treatment of TBM and to control the spread of tuberculosis.关键词
结核,脑膜/脑脊液/脑部疾病,代谢/早期诊断/传染病控制Key words
Tuberculosis,meningeal/Cerebrospinal fluid/Brain diseases,metabolic/Early diagnosis/Communicable disease control分类
医药卫生引用本文复制引用
汪晨媛,王珊珊,王赛楠,邵戈,曹佳颐,熊海燕,胡屹..脑脊液特征指标辅助结核性脑膜炎快速筛查的效果评估[J].中国防痨杂志,2024,46(3):311-317,7.基金项目
National Natural Science Foundation of China(81874273)国家自然科学基金(81874273) （81874273）
