Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India.
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India.
J Neuroimmunol. 2022 Nov 15;372:577954. doi: 10.1016/j.jneuroim.2022.577954. Epub 2022 Aug 28.
Blood -cerebrospinal fluid-barrier (BCB) disruption in tuberculous meningitis (TBM) may be mediated by inflammatory cytokines, and may determine clinico-radiological severity and outcome. We report BCB permeability in TBM and its relationship with inflammatory cytokines (TNF-α, IL-1β and IL-6), clinical severity, MRI changes and outcome. 55 TBM patients with a median age of 26 years were included. Their clinical, cerebrospinal fluid (CSF) and MRI findings were noted. The severity of meningitis was graded into stages I to III. Cranial MRI was done, and the presence of exudates, granuloma, hydrocephalus and infarctions was noted. BCB permeability was assessed by a ratio of CSF albumin to serum albumin (Q). The concentration of TNF-α, IL-1β and IL-6 in CSF were measured by cytokine bead array. The Q in the patients was more than the mean + 2.5 SD of controls. In TBM, Q correlated with TNF- α (r = 0.47; p = 0.01), CSF cells (r = 0.29; p = 0.02) and exudate on MRI (0.18 ± 0.009 Vs 0.13 ± 0.008; p = 0.04). There was however no association of Q with demographic variables, stage, tuberculoma, infarction and hydrocephalus. At 6 months, 11(20%) died, 10(18.2%) had poor and 34(61.8%) had a good recovery. BCB permeability in TBM correlated with TNF-α, CSF pleocytosis and exudates but not with severity of meningitis and outcome.
结核性脑膜炎（TBM）中血脑屏障（BCB）的破坏可能是由炎症细胞因子介导的，并可能决定临床放射学的严重程度和结果。我们报告了 TBM 中的 BCB 通透性及其与炎症细胞因子（TNF-α、IL-1β 和 IL-6）、临床严重程度、MRI 变化和结果的关系。纳入了 55 名中位年龄为 26 岁的 TBM 患者。记录了他们的临床、脑脊液（CSF）和 MRI 发现。将脑膜炎的严重程度分为 I 至 III 期。进行了颅 MRI，并注意到渗出物、肉芽肿、脑积水和梗塞的存在。通过 CSF 白蛋白与血清白蛋白（Q）的比值评估 BCB 通透性。通过细胞因子珠阵列测量 CSF 中 TNF-α、IL-1β 和 IL-6 的浓度。患者的 Q 值高于对照组的均值+2.5SD。在 TBM 中，Q 值与 TNF-α（r=0.47；p=0.01）、CSF 细胞（r=0.29；p=0.02）和 MRI 上的渗出物相关（0.18±0.009 vs 0.13±0.008；p=0.04）。然而，Q 值与人口统计学变量、分期、结核瘤、梗塞和脑积水均无相关性。6 个月时，11 人（20%）死亡，10 人（18.2%）预后不良，34 人（61.8%）恢复良好。TBM 中的 BCB 通透性与 TNF-α、CSF 白细胞增多和渗出物相关，但与脑膜炎的严重程度和预后无关。
