摘要
目的探讨结核性脑膜炎（下称结脑）患者免疫异常与临床、预后的关系，以及不同剂量肾上腺皮质类固醇对结脑患者临床及免疫学参数的影响。方法用ＢｅｃｋｍａｎＩＣＳ－Ⅱ免疫化学分析仪，以速率散射比浊法，对７３例结脑患者血清、脑脊液配对标本进行γ－免疫球蛋白（ＩｇＧ）、白蛋白（Ａｌｂ）检测，并计算出中枢神经系统每２４小时鞘内ＩｇＧ合成率（ＩｇＧ－ｓｙｎ）。结果结脑组脑脊液Ａｌｂ、ＩｇＧ、ＩｇＧ－ｓｙｎ明显高于对照组（Ｐ＜００１），而且ＩｇＧ－ｓｙｎ与病情严重程度有关。肾上腺皮质类固醇治疗后，随临床症状的改善，ＩｇＧ－ｓｙｎ亦同步降低，渐趋正常。对５９例出院患者６～３６个月的随访，病初ＩｇＧ－ｓｙｎ＞１５．８２ｍｇ／ｄ者１２个月复发１０例１２次，复发率明显高于ＩｇＧ－ｓｙｎ≤１５．８２ｍｇ／ｄ者的２例次（Ｐ＜００１）。结论ＩｇＧ－ｓｙｎ可以作为结脑患者病情严重程度、疗效及预后判断的重要指标。激素对结脑有效，大剂量用药可缩短结脑的病程。
Objective To study the relationship between abnormal immunity and clinic and
prognosis and also the effects of different doses of corticosteroids on the clinic and
immunological parameters in patients with tuberculous meningitis.Methods Albumin and gama
immunoglobulin (IgG) of the paired cerebrospinal fluid (CSF) and serum (S) sample from 61
normal subjects and 73 patients with tuberculous meningitis were detected by
rate-nephelometers immuno-chemistry system,and CSF/S albumin ratio and intrathecal IgG
synthesis rate were also calculated based on Tourtellotte's formula.Results The mean values
of IgG,albumin and intrathecal IgG synthesis rate and CSF/S albumin ratio tuberculous
meningitis group were significantly higher than that of the normal group ( P <0 01).It was also
found that the clinical manifestation correlate with the levels of IgG synthesis rate.The patients
treated with corticosteroid were clinically improved and IgG sinthesis rate decreased tended to
normalize.6～36 monthsl Followed-up of 59 patients indicated that the recurrence rate of
patients with high intrathecal IgG synthesis onset was significantly higher than that of patients
with lower intrathecal IgG synthesis onset ( P <0.01).Conclusions detertion of intrathecal IgG
synthesis in uberculous meningitis patients should be considered as an important index for
assessing the severity and prognosis.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
1999年第2期77-79,共3页
Chinese Journal of Practical Internal Medicine
关键词
结核性脑膜炎
鞘内
IGG
合成率
Tuberculous meningitis\ Intrathecal IgG
synthesis rate\ Corticosteroid
