Objective: To explore the diagnostic value of cerebrospinal fluid (CSF) adenosine deaminase (ADA) level in tuberculous meningitis. Methods: We retrospectively analyzed 139 patients (73 males, 66 females) who visited Beijing Chest Hospital for suspected TBM from January 2010 to June 2015. Of them, 99 patients were diagnosed to have TBM, with 45 males and 54 females, and a mean age of (33±15) years. Forty patients were diagnosed as having Non-TBM, with 28 males and 12 females, and a mean age of (35±18) years. All patients underwent lumbar puncture, and CSF ADA, routine, biochemical and bacteriological tests were performed. Thirty-five TBM patients reviewed CSF ADA test after treatment for 4 weeks, 8 weeks and 6 months. Results: The level of CSF ADA in TBM group was higher than that in the non-TBM group, the difference being statistically significant (5.6 U/L vs 2.3 U/L, P=0.000). When the cut-off value of the CSF ADA was 3.8 U/L , the sensitivity and specificity for diagnosis of TBM were 60.6% (95%CI 50.3%-70.1%) and 87.5% (95%CI 72.4%-95.3%), respectively, and the area under the ROC curve was 0.734.The CSF ADA level was (6.7±4.2) U/L in the 35 cases of TBM before treatment. After 4 weeks, 8 weeks and 6 months of anti-tuberculosis treatment, the CSF ADA levels were (4.5±3.3) U/L, (3.7±2.7) U/L and (2.0±1.5) U/L, respectively; all significantly decreased as compared to that before treatment (P<0.001). There was no significant change in the ADA level between 8 weeks and 4 weeks (P=0.128). After 6 months of treatment, the level of CSF ADA was significantly lower than those after 4 and 8 weeks' treatment (P<0.001). Conclusions: CSF ADA in TBM patients was significantly higher than in non-TBM patients. The sensitivity of CSF ADA level in the diagnosis of TBM was poor, but the specificity was better. CSF ADA was significantly reduced and showed dynamic changes with effective anti-tuberculosis treatment and maybe helpful in evaluating the effect of treatment.
目的： 检测结核性脑膜炎患者不同时期脑脊液中腺苷脱氨酶(ADA)的水平及其动态变化，探讨其对结核性脑膜炎(TBM)的诊断价值。 方法： 回顾性分析2010年1月至2015年6月北京胸科医院疑诊为TBM的患者139例，男73例，女66例，年龄14～83岁，平均(34±16)岁。139例中结核性脑膜炎患者99例，男45例，女54例，年龄14～83岁，平均(33±15)岁。非结核性脑膜炎患者40例，男28例，女12例，年龄15～82岁，平均(35±18)岁。所有患者均进行腰椎穿刺并行脑脊液ADA检测。其中35例结核性脑膜炎患者在治疗后4周、8周及6个月后复查脑脊液ADA水平。本研究为病例回顾性研究。 结果： 结核性脑膜炎组脑脊液ADA的中位数为5.6 (2.4，8.3) U/L，较非结核性脑膜炎组[2.3(1.8，3.0) U/L]明显升高，差异有统计学意义(U＝1052, P＝0.000)。脑脊液ADA检测的临界值为3.8 U/L时，其诊断结核性脑膜炎的敏感度和特异度分别为60.6%(60/99，95%CI为50.3%～70.1%)和87.5%(35/40，95%CI为72.4%～95.3%)，受试者工作曲线(ROC曲线)下面积为0.734。35例结核性脑膜炎患者治疗前脑脊液ADA含量平均为(6.7±4.2) U/L，治疗4周、8周及6个月后分别为(4.5±3.3)、(3.7±2.7)和(2.0±1.5) U/L，均较治疗前明显下降(均P<0.001)。治疗8周与治疗4周相比ADA含量无明显变化(P＝0.128)。治疗6个月与治疗4周及8周相比ADA含量均明显降低(均P<0.001)。 结论： 结核性脑膜炎患者脑脊液ADA含量明显高于非结核性脑膜炎患者，脑脊液ADA水平诊断结核性脑膜炎的敏感度欠佳，但特异度较好。脑脊液ADA水平随着有效的抗结核治疗明显降低并呈现动态变化，有助于评价抗结核治疗的效果。.
Keywords: Adenosine deaminase; Cerebrospinal fluid; Tuberculous meningieal.