Ngiam Jinghao Nicholas, Koh Matthew Chung Yi, Lye Priscillia, Liong Tze Sian, Ong Lizhen, Tambyah Paul Anantharajah, Somani Jyoti
Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore.
Department of Medicine, National University Health System, Singapore.
Singapore Med J. 2024 Sep 3. doi: 10.4103/singaporemedj.SMJ-2023-155.
Tuberculous meningitis (TBM) can be difficult to diagnose. Elevated cerebrospinal fluid (CSF) adenosine deaminase (ADA) is often seen in TBM, but its reliability has been questioned. A previous meta-analysis in 2017 had demonstrated the diagnostic utility of CSF ADA in TBM versus non-TBM. We sought to update this meta-analysis with more recent studies, to determine whether CSF ADA could be used to aid in the early recognition of TBM.
Electronic searches were performed in PubMed and Scopus on studies published from 2016 to 2022. Ten additional studies were identified and added to 20 studies (from 2000 to 2016) from a previous meta-analysis. Meta-analysis was conducted using the random effects method, estimating the pooled diagnostic odds ratio (DOR) for elevated CSF ADA in the diagnosis of TBM.
Of the 30 studies included, 16/30 (53.3%) used the Giusti method for measuring ADA. Fourteen (46.7%) studies used an ADA cut-off of 10 IU/L, and 11 (36.7%) studies used an even lower cut-off. The pooled DOR for elevated CSF ADA in the diagnosis of TBM was 45.40 (95% confidence interval [CI] 31.96-64.47, I2 = 44%). When only studies using the Giusti method were considered, DOR was 44.21 (95% CI 28.37-68.91, I2 = 40%). Among the studies that used a cut-off of 10 IU/L, DOR was 58.09 (95% CI 33.76-99.94, I2 = 41%).
Studies remain heterogeneous but demonstrate that CSF ADA can differentiate TBM from non-TBM. In line with most studies, CSF ADA >10 IU/L supports the diagnosis of TBM in a patient with compatible symptoms and high-risk epidemiology.
结核性脑膜炎（TBM）可能难以诊断。脑脊液（CSF）腺苷脱氨酶（ADA）升高在TBM中经常可见，但其可靠性受到质疑。2017年的一项先前的荟萃分析证明了CSF ADA在TBM与非TBM诊断中的效用。我们试图用更新的研究来更新这项荟萃分析，以确定CSF ADA是否可用于帮助早期识别TBM。
在PubMed和Scopus上对2016年至2022年发表的研究进行电子检索。另外确定了10项研究，并将其添加到先前荟萃分析中的20项研究（2000年至2016年）中。使用随机效应方法进行荟萃分析，估计CSF ADA升高在TBM诊断中的合并诊断比值比（DOR）。
在纳入的30项研究中，16/30（53.3%）使用Giusti方法测量ADA。14项（46.7%）研究使用ADA临界值为10 IU/L，11项（36.7%）研究使用更低的临界值。CSF ADA升高在TBM诊断中的合并DOR为45.40（95%置信区间[CI]31.96 - 64.47，I2 = 44%）。仅考虑使用Giusti方法的研究时，DOR为44.21（95%CI 28.37 - 68.91，I2 = 40%）。在使用临界值为10 IU/L的研究中，DOR为58.09（95%CI 33.76 - 99.94，I2 = 41%）。
研究仍然存在异质性，但表明CSF ADA可以区分TBM与非TBM。与大多数研究一致，CSF ADA>10 IU/L支持对具有相符症状和高危流行病学特征的患者诊断TBM。
