در مايع مغزي - نخاعي بيماران مبتلا به مننژيت سلي ADA ميزان آنزيم آدنوزين و آميناز

Diagnostic evaluation of adenosine deaminase in cerebrospinal fluid in tuberculous meningitis

Introduction: Diagnosis of tuberculous meningitis is one of the most complex issues in medicine. Ear/i diagnosis decreases the mortality rate and neurological deficits of the disease. Current methods of diagnosis of TB meningitis are either expensive (e.g. PCR) and limited to reference research centers (e.g. gas hold chromatography) or have low sensitivity in cerebrospinal fluid (CSF). Also, like other Mycobacteria, culture could take a long time to give results. The aim of this case- control study was to determine the importance nl different levels of adenosine deaminase (ADA) enzyme in early diagnosis of the disease by measuring it ʹ, different levels in CSF which is a relatively cheap and fast method. Also, It was intended to determine the best cut off point in comparison to other studies. Methods: Seventy-one admitted patients with diagnosis of meningitis were divided into two groups: 15 patients us TB and 56 patients as non TB group. The level of ADA and routine tests on CSF of all the patients have been performed in one laboratory. HIV positive patients were excluded from the study. Results: The ADA mean in the, first group was 20.8 IU/L (± 13.24) and 9.75 IU/L (I 5.85) in the second group, which showed a significant difference in the two groups (p=0.001). None of the variables like glucose, protein level, white blood cells count and lymphocyteʹs percentage in the CSF result were confounding factors. The sensitivity and specificity in the cut off point >11 IU/L for the ADA enzyme ill diagnosis of TB meningitis was 73% and 66%, respectively. Conclusion: The results of some studies show that the cut off point in Spain, Chile, india and Malaysia are lower than that of ours. Therefore, the sole measurement of this enzyme is not useful and it is necessary to take other, factors into account far early diagnosis.