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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 investigate the relationship between the immunological abnormalities in patients with tuberculous meningitis (tuberculous meningitis) and clinical and prognosis as well as the clinical and immunological parameters of patients with tuberculous meningitis after different doses of adrenal corticosteroids. Methods Serum and cerebrospinal fluid samples of 73 patients with tuberculous meningitis were detected by BeckmanICS-Ⅱ immunochemical analyzer and rate nephelometry. The levels of IgG and ALB were measured and the central nervous system System intrathecal IgG synthesis rate (IgG-syn) every 24 hours. Results Cerebrospinal fluid Alb, IgG and IgG-syn in the Jiebna group were significantly higher than those in the control group (P <001), and IgG-syn was associated with the severity of the disease. After treatment with adrenal corticosteroids, with the improvement of clinical symptoms, IgG-syn also simultaneously reduced, getting normal. Fifty-nine patients discharged from hospital were followed up for 6 to 36 months. The initial relapse of 12 patients with IgG-syn> 15.82mg / d at the beginning of the disease was 12 and the recurrence rate was significantly higher than those with IgG-syn≤15.82mg / d 2 cases (P <001). Conclusion IgG-syn can be used as an important indicator of the severity of disease, efficacy and prognosis in patients with tuberculous meningitis. Hormones on the brain effectively, high-dose medication can shorten the course of tuberculosis.