本文旨在研究脑脊液(CSF)免疫球蛋白在鉴别诊断中的价值。预测,结核性脑膜炎(TBM)的预后。收集我院65例TBM患者的临床资料,65例隐球菌性脑膜炎(CM)患者以1:1匹配方式入组。收集相关数据进行比较。CSFsIgG[331.51(164.85,645.00)vs129.00(55.05,251.00)ng/mL],IgM[22.38(8.52,40.18)vs6.08(2.19,23.30)ng/mL],TBM组的IgA[64.11(21.44,115.48)比16.55(4.76,30.36)ng/mL]均高于CM组(P<0.001)。在TBM组中,治疗24周后,CSFsIgG,IgM,IgA显著下降,差异有统计学意义(P<0.05)。脑脊液免疫球蛋白对TBM的预测结果显示,IgM,IgA对TBM都有一定的预测价值,三者的综合预测值最高,曲线下面积为0.831(95%CI:0.774-0.881)。脑脊液免疫球蛋白和TBM预后的Logistic回归分析显示IgG[比值比(OR)=4.796,95%置信区间(CI):2.575-8.864],IgM(OR=3.456,95%CI:2.757-5.754),IgA(OR=4.371,95%CI:2.731-5.856)是TBM患者预后不良的危险因素。IgG的水平,IgM,脑脊液IgA与TBM患者头颅磁共振成像(MRI)严重程度呈正相关(R2=0.542,F=65.392,P<0.05)。CSFsIgG,IgM,IgA可作为TBM患者的常规监测指标,对鉴别诊断和疗效评价具有一定的参考价值。
目的:在临床实践中,医生可以根据脑脊液(CSF)IgG水平确定患者的身体状况,IgM,还有IgA.更高水平的CSFsIgG,IgM,和IgA提示结核性脑膜炎的可能性更大,预后更差,磁共振成像表现。
This article aims to study the value of cerebrospinal fluid (CSF) immunoglobulin in differential diagnosis, prediction, and prognosis of tuberculous meningitis (TBM). The clinical data of 65 patients with TBM in our hospital were collected, and 65 patients with cryptococcal meningitis (CM) were enrolled in 1:1 matching. Relevant data were collected for comparison. CSFs IgG [331.51 (164.85, 645.00) vs 129.00 (55.05, 251.00) ng/mL], IgM [22.38 (8.52, 40.18) vs 6.08 (2.19, 23.30) ng/mL], and IgA [64.11 (21.44, 115.48) vs 16.55 (4.76, 30.36) ng/mL] in the TBM group were higher than those in the CM group (P < 0.001). In the TBM group, after 24 weeks of treatment, the CSFs IgG, IgM, and IgA were significantly decreased, and the difference was statistically significant (P < 0.05). The predictive results of CSF immunoglobulin for TBM showed that IgG, IgM, and IgA all had some predictive value for TBM, and the combined predictive value of the three was the highest, with an area under the curve of 0.831 (95% CI: 0.774-0.881). Logistic regression analysis of CSF immunoglobulins and TBM prognosis showed that IgG [odds ratio (OR) = 4.796, 95% confidence interval (CI): 2.575-8.864], IgM (OR = 3.456, 95% CI: 2.757-5.754), and IgA (OR = 4.371, 95% CI: 2.731-5.856) were TBM risk factors for poor prognosis in patients. The levels of IgG, IgM, and IgA in CSF were positively correlated with the severity of cranial magnetic resonance imaging (MRI) in TBM patients (R2 = 0.542, F = 65.392, P < 0.05). CSFs IgG, IgM, and IgA can be used as a routine monitoring index for TBM patients, which has a certain reference value in differential diagnosis and efficacy evaluation.
OBJECTIVE: In clinical practice, physicians can determine the physical conditions of patients based on the levels of cerebrospinal fluids (CSFs) IgG, IgM, and IgA. Higher levels of CSFs IgG, IgM, and IgA suggest more possibility of tuberculous meningitis and worse prognosis and magnetic resonance imaging manifestations.