Gupta Bharat Kumar, Bharat Anchit, Debapriya Bandyopadhyay, Baruah Haren
Department of Biochemistry, Subharti Medical College, S. V. S. University, Meerut- 250005, India.
J Clin Med Res. 2010 Oct 11;2(5):220-4. doi: 10.4021/jocmr429w.
Tuberculosis kills five lakh patients in India every year, out of which 7-12 % are with meningeal involvement. Delay in its diagnosis and in initiation of treatment results in poor prognosis and sequlae in up to 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective, non-invasive and fairly specific test in differentiating tubercular etiology from other causes.
Forty patients between the age of 6 - 24 months attending hospital with symptoms and signs of meningitis were selected and divided into two groups: tubercular and non-tubercular, depending upon the accepted criteria. CSF was drawn and ADA estimated.
Out of 19 tubercular patients, 18 had CSF ADA at or above the cutoff value while one had below. Out of 21 non-tuberculous patients, two had ADA levels at or above the cutoff value while 19 had below this value. Results of our study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of TBM, CSF ADA level 10 U/L as a cutoff value exhibited 94.73% sensitivity and 90.47% specificity in differentiating tuberculous from non-tuberculous meningitis; it also has 90.00% positive predictive value and 95.00% negative predictive value.
It can be concluded that ADA estimation in CSF is not only simple, inexpensive and rapid but also fairly specific method for making a diagnosis of tuberculous etiology in TBM, especially when there is a dilemma of differentiating the tuberculous etiology from non-tuberculous ones. For this reason ADA estimation in TBM may find a place as a routine investigation.
Cerebrospinal fluid; Adenosine deaminase; Tuberculous meningitis.
在印度，结核病每年导致50万患者死亡，其中7% - 12%的患者伴有脑膜受累。诊断和治疗开始的延迟会导致预后不良，高达25%的病例会出现后遗症。本研究的目的是寻找一种简单、快速、经济有效、非侵入性且具有相当特异性的检测方法，以区分结核病因与其他病因。
选取40例年龄在6 - 24个月、因脑膜炎症状和体征入院的患者，根据公认标准分为两组：结核组和非结核组。抽取脑脊液并测定腺苷脱氨酶（ADA）。
19例结核患者中，18例脑脊液ADA水平达到或高于临界值，1例低于临界值。21例非结核患者中，2例ADA水平达到或高于临界值，19例低于此值。我们的研究结果表明，脑脊液ADA水平测定不仅在结核性脑膜炎（TBM）的诊断中具有重要价值，以脑脊液ADA水平10 U/L作为临界值，在区分结核性脑膜炎与非结核性脑膜炎时，敏感性为94.73%，特异性为90.47%；其阳性预测值为90.00%，阴性预测值为95.00%。
可以得出结论，脑脊液ADA测定不仅简单、廉价、快速，而且是诊断TBM结核病因的相当特异的方法，特别是在区分结核病因与非结核病因存在困境时。因此，TBM中ADA测定可能会成为一项常规检查。
脑脊液；腺苷脱氨酶；结核性脑膜炎
