ESAT-6/CFP-10复合物、ManLAM联合Xpert MTB/RIF Ultra对结核性脑膜炎的鉴别诊断价值OA

Objective To evaluate the diagnostic performance of early secreted antigenic target 6(ESAT-6)/culture filtrate protein 10(CFP-10)complex,mannose-capped lipoarabinomannan(ManLAM),and Xpert MTB/RIF Ultra(Xpert Ultra)in the differential diagnosis of tuberculous meningitis(TBM).Methods This retrospective study included 142 patients with TBM(TBM group)and 142 patients with non-TBM meningitis(control group)admitted be-tween May 2022 and June 2025.Cerebrospinal fluid(CSF)samples were collected from all participants.The ESAT-6/CFP-10 complex concentration was measured using enzyme-linked immunosorbent assay(ELISA),ManLAM was de-tected by lateral flow assay(LFA),and Xpert Ultra was performed using real-time polymerase chain reaction.Differ-ences between groups were compared.Diagnostic performance-including sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy-was evaluated for individual and combined markers.Receiver operating characteristic(ROC)curves and area under the curve(AUC)were used to assess diagnostic efficacy.Results CSF ESAT-6/CFP-10 complex levels,ManLAM positivity rate,and Xpert Ultra positivity rate were all significantly higher in the TBM group than in the control group(P＜0.05).After adjusting for confounding factors including age,sex,comorbidities,and clinical characteristics,multivariate logistic regression analysis identified elevated ESAT-6/CFP-10 complex concentration(OR=2.699,95％CI:1.646-4.427),positive ManLAM(OR=6.961,95％CI:3.251-14.905),and positive Xpert Ultra(OR=5.648,95％CI:2.789-11.441)as independent predictors for TBM diagnosis(P＜0.05).The AUC values for ESAT-6/CFP-10 complex,ManLAM,Xpert Ultra,and their combination were 0.967,0.863,0.923,and 0.997,respectively.The combined model demonstrated significantly superior diagnostic per-formance compared with ManLAM or Xpert Ultra alone(Z=6.103 and 3.896,respectively;P＜0.05),but showed no significant difference compared with ESAT-6/CFP-10 complex alone(Z=0.267,P=0.789).Notably,the ESAT-6/CFP-10 complex exhibited higher sensitivity,specificity,PPV,NPV,and overall accuracy than either ManLAM or Xpert Ultra.Conclusion CSF ESAT-6/CFP-10 complex levels,ManLAM positivity,and Xpert Ultra positivity are all significantly elevated in patients with TBM and serve as independent diagnostic indicators.Combined detection further im-proves diagnostic performance compared with ManLAM or Xpert Ultra alone,providing a reliable strategy for early and ac-curate differentiation of TBM,thereby reducing misdiagnosis and missed diagnosis.