Comparison of the different methods in the diagnosis of tuberculous meningitis

ZHANG Chunyan; CHI Fei; ZHANG Xin; ZHANG Xiumin; SUN Jinhao

doi:10.3969/j.issn.1671-6450.2017.04.009

Abstract：Objective To evaluate the clinical value of PPD and tuberculosis antibody (38KDa antibody, 16KDa an-tibody, LAM antibody), peripheral blood interferon gamma release test , cerebrospinal fluid ADA, serum ADA and cerebro-spinal fluid cerebrospinal fluid acid fast stain , bacterial culture in early diagnosis of tuberculous meningitis .Methods Se-lected 62 cases of tuberculous meningitis and 60 cases of others .The positive rate in tuberculous meningitis was detected by seven methods .We draw ROC curve of diagnosis methods , calculate the area under ROC curve , and compare of sensitivity , specificity, accuracy, positive and negative likelihood ratio , Youden index in different methods .Results The area under ROC curve ofγinterferon release experiment in the peripheral blood was 0.893.ADA in serum and cerebrospinal fluid has a higher area under the curve , namely 0.794 and 0.812.Under the ROC curves obtained serum ADA best point was 17.3 U/L, cerebrospinal fluid ADA best point was 7.61 U/L.The sensitivity and specificity ofγinterferon release test were 90.3%and 88.3%, Youden index was 0.786, and accuracy was 89.3%.The sensitivity and specificity of serum ADA were 80.6%and 70.0%, Youden index was 0.506, and accuracy was 75.4%.The sensitivity and specificity of cerebrospinal fluid ADA were 61.3%and 90.0%, Youden index was 0.513, and accuracy was 75.4%.The above 3 methods are better than other meth-ods.Conclusion Interferon release test has high value for early diagnosis of tuberculous meningitis , and serum ADA and ce-rebrospinal fluid ADA also has good accuracy .