Shankar P, Manjunath N, Mohan K K, Prasad K, Behari M, Ahuja G K
Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Lancet. 1991 Jan 5;337(8732):5-7. doi: 10.1016/0140-6736(91)93328-7.
The polymerase chain reaction (PCR) in cerebrospinal fluid was compared with conventional bacteriology and an enzyme-linked immunosorbent assay (ELISA) for cerebrospinal fluid antibodies in the diagnosis of tuberculous meningitis (TBM). PCR was the most sensitive technique; it detected 15 (75%) of 20 cases of highly probable TBM (based on clinical features), 4 (57%) of 7 probable cases, and 3 (43%) of 7 possible cases. ELISA detected 11 (55%) of the highly probable cases and 2 each of the probable and possible cases. Culture was positive in only 4 of the highly probable cases. Among the controls (14 pyogenic meningitis, 3 aseptic meningitis, 34 other neurological disorders), 6 subjects tested early in the study (2 pyogenic meningitis, 4 other disorders) were PCR positive. Second DNA preparations from their stored cerebrospinal fluid samples were all PCR negative, suggesting that the false-positive results were due to cross-contamination. 18 PCR-positive TBM samples retested were all still PCR positive. The antibody ELISA was positive in 3 controls despite the use of a high cutoff value.
将脑脊液中的聚合酶链反应（PCR）与传统细菌学方法以及脑脊液抗体酶联免疫吸附测定（ELISA）进行比较，以诊断结核性脑膜炎（TBM）。PCR是最敏感的技术；在20例高度疑似TBM的病例（基于临床特征）中检测到15例（75%），在7例疑似病例中检测到4例（57%），在7例可能病例中检测到3例（43%）。ELISA在高度疑似病例中检测到11例（55%），在疑似病例和可能病例中各检测到2例。培养仅在4例高度疑似病例中呈阳性。在对照组（14例化脓性脑膜炎、3例无菌性脑膜炎、34例其他神经系统疾病）中，研究早期检测的6名受试者（2例化脓性脑膜炎、4例其他疾病）PCR呈阳性。从他们储存的脑脊液样本中进行的第二次DNA制备所有PCR均为阴性，表明假阳性结果是由于交叉污染。重新检测的18份PCR阳性TBM样本仍均为PCR阳性。尽管使用了高临界值，抗体ELISA在3名对照中呈阳性。
