The application of neuron-specific enolase, matrix metalloproteinase-9, adenosine deaminase and tumor necrosis factor-alpha in the diagnosis of tuberculous meningitis

Objective To study the application of neuron-specific enolase (NSE),matrix metalloproteinase-9 (MMP-9),adenosine deaminase (ADA) and tumor necrosis factor-alpha (TNF-α)level in cerebrospinal fluid for diagnosis of tuberculous meningitis (TBM).Methods The clinical manifestations,and NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid on admission and convalescence were compared between 57 patients with TBM (TBM group) and 49 patients with non-TBM (non-TBM group,including 3.1 cases of viral meningitis and 18 cases of non-tuberculous bacterial meningitis).Results The headache,fever,meningeal irritation,disturbance of consciousness,respectively accounted for 89.5％ (51/57),93.0％ (53/57),86.0％ (49/57) and 56.1％ (32/57) in TBM group,91.8％ (45/49),95.9％(47/49),85.7％ (42/49) and 59.2％(29/49) in control group,there was no significant difference between two groups (P ＞ 0.05).NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid of TBM group on admission were (17.2±6.3) μg/L,(82.3 ± 14.5) μg/L,(14.5 ±5.4) U/L,(87.9 ± 16.1) μ g/L,which were higher than those of control group [(11.7 ± 4.2) μg/L,(42.9 ± 11.3) μg/L,(4.3 ±2.0) U/L,(79.3 ± 14.6) μg/L],there were significant differences (P ＜ 0.05).NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid of TBM group on convalescence decreased to (6.5 ± 2.1) μg/L,(16.7 ± 4.1) μg/L,(6.1 ± 2.3) U/L and (41.7 ± 12.8) μg/L,while which of control group were (6.3 ± 2.3) μg/L,(12.1 ± 3.2)μg/L,(4.1 ±2.1) U/L and (32.9 ± 11.3)μg/L The above-mentioned factors in both groups were all significandy decreased (P ＜0.05),but MMP-9,ADA and TNF-α levels in cerebrcepinal fluid of TBM group were still higher than those of control group (P ＜ 0.05).NSE,MMP-9 and ADA levels in cerebrospinal fluid of acute onset TBM patients (38 cases) on admission were (19.5 ± 6.7) μg/L,(87.9 ± 16.1) μg/L and (17.2 ± 6.3) U/L,which were significantly higher than those of subacute onset TBM patients (19 cases)[(14.9 ±5.1) μg/L,(76.7 ± 13.5) μg/L and (11.8 ±5.1) U/L] (P ＜0.05 or ＜0.01),there was no significant difference in TNF-α levels(P＞ 0.05).Conclusion NSE,MMP-9,ADA and TNF-α levels in cerebrospinal fluid may provide the evidence for early diagnosis and differential diagnosis of TBM. Key words: Phosphopyruvate hydratase;  Matrix metalloproteinase 9;  Adenosine deaminase; Tuberculosis, meningeal