The validity of cerebrospinal fluid parameters for the diagnosis of tuberculous meningitis
The validity of cerebrospinal fluid parameters for the diagnosis of tuberculous meningitis
复制标题
DOI：
10.1016/j.ijid.2013.06.003
复制
发表时间：
2013-12-01
影响因子：
8.4
通讯作者：
van der Stuyft, Patrick
中科院分区：
文献类型：
--
作者：
Solari, Lely;Soto, Alonso;van der Stuyft, Patrick
目的：为了评估实验室脑脊液（CSF）参数的诊断有效性区分结核性脑膜炎（TBM）和脑膜综合征的其他原因在高结核病发病率settings.Methods：从2009年11月至2011年11月，我们纳入了临床怀疑脑膜炎参加两个医院在利马，秘鲁的患者。使用复合参考标准，我们将其分类为明确的TBM，可能的TBM和非TBM病例。我们评估了有效性的四个CSF参数，在隔离和不同的组合，用于诊断TBM：腺苷脱氨酶活性（ADA），蛋白质水平，葡萄糖水平，和淋巴细胞pleocytosis.Results：一百五十七例患者被纳入; 59有一个最终诊断为TBM（18确认和41可能）。ADA是性能最好的参数。其特异性为95%，阳性似然比为10.7，受试者工作特征曲线下面积为82.1%，但敏感性较低（55%）。CSF参数的组合都没有达到一个公平的性能为'排除' TBM.Conclusions：发现脑脊液ADA大于6 U/L的脑膜综合征患者强烈支持诊断的TBM，并允许开始抗结核治疗。(C)2013年国际传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To assess the diagnostic validity of laboratory cerebrospinal fluid (CSF) parameters for discriminating between tuberculous meningitis (TBM) and other causes of meningeal syndrome in high tuberculosis incidence settings.Methods: From November 2009 to November 2011, we included patients with a clinical suspicion of meningitis attending two hospitals in Lima, Peru. Using a composite reference standard, we classified them as definite TBM, probable TBM, and non-TBM cases. We assessed the validity of four CSF parameters, in isolation and in different combinations, for diagnosing TBM: adenosine deaminase activity (ADA), protein level, glucose level, and lymphocytic pleocytosis.Results: One hundred and fifty-seven patients were included; 59 had a final diagnosis of TBM (18 confirmed and 41 probable). ADA was the best performing parameter. It attained a specificity of 95%, a positive likelihood ratio of 10.7, and an area under the receiver operating characteristics curve of 82.1%, but had a low sensitivity (55%). None of the combinations of CSF parameters achieved a fair performance for 'ruling out' TBM.Conclusions: Finding CSF ADA greater than 6 U/l in patients with a meningeal syndrome strongly supports a diagnosis of TBM and permits the commencement of anti-tuberculous treatment. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.