流行性腮腺炎脑膜脑炎血清及脑脊液特异性IgM抗体检测

流行性腮腺炎仍是我国小儿常见的传染病之一 ,其最常见的并发症为脑膜脑炎。为协助临床明确诊断 ,我们对９７例于１９９８年１月至５月临床诊断为流行性腮腺炎脑膜脑炎的住院患儿进行血清和／或脑脊液腮腺炎病毒ＩｇＭ抗体的检测 ,现报告如下。资料和方法一、临床资料１９９８年１月至５月临床诊断为流行性腮腺炎脑膜脑炎的住院患儿９７例 ,男７３例 ,女２４例 ,男女之比为３∶１ ;年龄１岁～１３岁 ,其中＜３岁１０例 ,～６岁４７例 ,～９岁２７例 ,～１３岁１３例。所有病例除有发热及腮腺和／或颌下腺肿痛外 ,均伴有头痛、呕吐 ,无１例发…     

腮腺炎脑膜脑炎脑脊液和血液β2微球蛋白测定及临床意义

目的探讨腮腺炎脑膜脑炎(腮脑)患儿脑脊液和血液β2微球蛋白(β2M)含量及其临床意义,比较细菌性和病毒性脑膜炎脑脊液β2水平.方法放射免疫法.结果腮脑急性期脑脊液和血液β2M均明显高于正常,β2M恢复期脑脊液下降;4例细菌性脑膜炎脑脊液β2M高于腮脑.结论中枢神经系统(CNS)感染时β2M在颅内局部合成.脑脊液β2M含量测定对于CNS的细菌性和病毒性感染有一定鉴别诊断价值.     

流行性腮腺炎合并脑膜脑炎患儿血清及脑脊液SIL-2R和TNF-α检测及其临床意义

目的探讨流行性腮腺炎合并脑膜脑炎(简称腮脑)时血清及脑脊液中细胞因子的水平及其临床意义。方法对57例腮脑患儿血清及脑脊液中SIL-2R、TNF-α的水平进行检测。结果血清中SIL-2R和TNF-α明显高于对照组,脑脊液中SIL-2R、TNF-α亦比对照组有一定的升高。结论腮腺炎合并脑膜脑炎的发病与SIL-2R、TNF-α密切相关。     

肋腺炎脑膜脑炎脑脊液和血液β2微球蛋白测定及临床意义

目的探讨腮腺炎脑膜脑炎(腮脑)患儿脑脊液和血液β2微球蛋白(β2M)含量及其临床意义,比较细菌性和病毒性脑膜炎脑脊液β2水平。 方法放射免疫法。 结果腮脑急性期脑脊液和血液β2M均明显高于正常,β2M恢复期脑脊液下降;4例细菌性脑膜炎脑脊液β2M高于腮脑。 结论中枢神经系统(CNS)感染时β2M在颅内局部合成。脑脊液β2M含量测定对于CNS的细菌性和病毒性感染有一定鉴别诊断价值。     

病毒性脑膜脑炎患儿脑脊液细胞学和细胞因子检测的意义

目的探讨病毒性脑膜脑炎患儿脑脊液(CSF)细胞学检测和细胞因子的意义。方法将79例病毒性脑膜脑炎患儿按病情分为轻症组和重症组,采用腰椎穿刺术采集CSF进行常规和细胞因子检测,另取CSF检测正常的64例儿童为对照组,比较3组CSF细胞学检测和生化检测结果。结果对照组、轻症组和重症组CSF淋巴细胞阳性率分别为12.5%、63.41%和86.11%,TNF-α水平分别为(6.37±1.48)mg.L-1、(22.75±6.68)mg.L-1和(53.41±7.74)mg.L-1,3组间比较差异有统计学意义(P<0.01);轻症组和重症组CSF单核细胞和神经元特异性烯醇化酶阳性率均显著高于对照组,但2组间差别无统计学意义。结论 CSF淋巴细胞数和TNF-α可作为脑损伤轻重程度的判定标准,单核细胞和神经元特异烯醇化酶也可作为脑损伤的依据之一。     

腮腺炎病毒性脑膜脑炎144例脑电图与临床分析

我院 1997年 7月～ 1999年 10月对 144例腮腺炎病毒性脑膜脑炎 (腮脑 )患儿进行脑电图描记 ,现报告如下临床资料一、一般资料　本组男 10 5例 ,女 39例。年龄 1～ 14ａ ,其中 1～ 5ａ 2 0例 ,～ 9ａ 10 1例 ,～ 14ａ 2 3例。二、诊断标准　 1.有腮腺炎接触史。 2 .急性起病 ,发热 ,腮腺和 (或 )颌下腺肿胀。 3.头痛 ,频繁呕吐 ,少部分有惊厥或昏迷和 (或 )脑膜刺激征阳性。 4.脑脊液检查符合病毒性脑膜脑炎改变。分型 :轻型 :频繁呕吐或明显头痛 ;中型 :轻型加嗜睡及脑膜刺激征阳性 ;重型 :中型加昏迷 ,惊厥等。本组 8例仅有发热或头晕、乏…     

腮腺炎病毒性脑膜脑炎儿T淋巴细胞亚群变化及意义

本文报告 42例急性腮腺炎病毒性脑膜脑炎 (简称腮脑 )儿外周血Ｔ淋巴细胞亚群变化及动态测定 ,并对腮脑儿Ｔ淋巴细胞亚群变化的原因及意义进行初步探讨。对象与方法一、对象　我科 1999～ 2 0 0 0年住院腮脑儿 42例 ,男 2 3例 ,女 19例 ,年龄 3～ 11ａ ,平均 6 .5ａ ,根据脑脊液常规生化检查及临床表现诊断。腮腺肿大 35例 ,颌下腺肿大 7例 ,抽搐 3例。脑电图轻度异常 10例 ,中度异常 2 3例 ,重度异常 9例 ,均无胰腺炎、睾丸炎合并症 ,血淀粉酶均升高 ,均治愈 ,发病至治愈时间 16 .1± 6 .3ｄ ,退热时间 7.6± 4.5ｄ。血清腮腺炎病毒抗体Ｉ…     

流行性腮腺炎并脑膜脑炎患儿脑脊液中酶的变化

脑脊液(CSF)内含有数十种酶。在脑部疾患时,如炎症、出血、肿瘤、外伤等,这些酶均有不同程度的变化。本通过对40例流行性腮腺炎合并脑膜脑炎(腮脑)患儿CSF中天门冬氨酸转移酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CPK)的测定,以探讨其CSF酶活性变化,并就其诊断价值进行了讨论。     

病毒性脑炎患儿脑脊液一氧化氮的变化及临床意义

目的：探讨病毒性脑炎患儿脑脊液一氧化氮（NO）变化的临床意义。方法：应用硝酸还原酶法测定病毒性脑炎60例脑脊液中NO的含量，与非中枢神经系统感染15例患儿作对照组，用t检验进行对比分析。结果：病毒性脑炎患儿脑脊液中NO的含量明显高于对照组，急性期明显高于恢复期，应用地塞米松治疗者脑脊液NO含量明显低于未用地塞米松治疗者。结论：1、NO参与病毒性脑炎脑损伤的过程；2、在病毒性脑炎的早期治疗中，若能应用一氧化氮合酶（NOS）抑制剂，使NO调控在一个适当的范围，即能抑制病毒复制，又不引起脑损伤，将是一种新的治疗措施；3、糖皮质激素的合理应用也应予以重视。     

病毒性脑炎患儿肠道病毒特异性IgM抗体快速检测

目的　为了证实固相反向免疫吸附试验（ＳＰＲＩＳＴ）是肠道病毒特异性ＩｇＭ 抗体的快速检测方法。方法　用ＳＰＲＩＳＴ检测６２ 例临床拟诊为病毒性脑炎患儿脑脊液（ＣＳＦ） 或ＣＳＦ 与血清中肠道病毒ＥＣＨＯ３ 、ＥＣＨＯ５、ＥＣＨＯ７ 、Ｃｏｘ Ｂ３ 特异性ＩｇＭ 抗体。结果　１７ 例（２７－４ ％ ）ＣＳＦ阳性,ＥＣＨＯ３ 、ＥＣＨＯ５、ＥＣＨＯ７ 和ＣＯＸＢ３ 的阳性数分别为５ 例、７ 例、１ 例和４ 例。结论　ＳＰＲＩＳＴ 快速检测肠道病毒特异性ＩｇＭ 抗体可用于中枢神经系统病毒感染的早期诊断,能够指导临床治疗,避免了滥用抗生素。     

Osmolality and electrolytes in cerebrospinal fluid and serum of febrile children with and without seizures

Abstract During acute febrile diseases mild disturbances of water and electrolyte balance occur frequently. It has been suggested that changes in electrolyte balance, in particular hyponatraemia, might predispose a child to convulsions during febrile illness; however, the changes of electrolytes in the CSF are not known.We have studied the effects of fever and convulsions on water and electrolyte balance in CSF and serum by measuring osmolality and electrolyte concentrations in children. The febrile population consisted of 60 children, 36 of whom had seizures during fever. Twenty-one children without convulsions and nine children with epileptic symptoms were nonfebrile controls. We noticed that CSF is subject to changes in osmolality and electrolyte concentration during fever, while convulsions do not exhibit such changes. CSF osmolality and sodium concentrations were lower in febrile children than in nonfebrile controls. The osmolality in febrile children with convulsions was 3.8% (P<0.01) and without seizures 3.5% (P<0.01) lower than in nonfebrile nonconvulsive children. The changes in CSF sodium concentration, and to a lesser extent potasium and chloride concentrations, paralleled those of CSF osmolality. A positive correlation was observed between the CSF and serum osmolatities (r=0.73,P<0.0001), and sodium concentrations (r=0.63,P<0.0001). A negative correlation between the body temperature and both CSF osmolality (r=–0.66,P<0.0001) and sodium concentration (r=–0.59,P<0.0001) exhibits also the important regulative role of increased body tmeperature.Conclusion Fever is an important factor for disturbances in fluid and electrolyte balance. The alterations in CSF osmolality and sodium concentration do not, however, give an unambiguous explanation for the susceptibility to simple febrile seizures.     

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目的总结170例脑脊液(CSF)细胞学的检查结果,分析其在小儿神经系统疾病或具有中枢神经系统表现疾病诊断中的临床意义。方法2000-06—2004-04河北省儿童医院对170例患儿进行CSF细胞学检查,CSF标本经玻片离心法制片,常规采用迈-格-姬染色后观察。结果CSF细胞学检查结果发现包括特异性病原体与恶性肿瘤,共4例,占全部CSF检查的2.3%,其中新型隐球菌2例,脑膜白血病2例。跟踪观察治疗前后CSF细胞学变化89例,其中结核性脑膜炎20例,化脓性脑膜炎29例,病毒性脑炎40例,治疗前后CSF细胞学检查主要表现为细胞成分及数量的变化。结论CSF细胞学检查对小儿神经系统疾病的临床诊断和治疗有重要意义,其特异性发现恶性肿瘤主要为脑膜白血病,病原体以新型隐球菌多见。脑脊液细胞学检查能直接、客观地评价临床疗效。     

化脓性脑膜炎患儿血清及脑脊液中C反应蛋白变化及临床意义

目的　探讨化脓性脑膜炎患儿血清和脑脊液(CSF)中C反应蛋白(CRP)变化及其与病原菌的关系。方法　将2 0 0 1年3月至2 0 0 4年3月在广西右江民族医学院附属医院住院的6 2例化脓性脑膜炎患儿分为革兰阳性(G+ )组与革兰阴性(G-)组,选取同期非感染患儿2 6例作为对照组,采用快速免疫透射比浊法分别检测血清和CSF中CRP质量浓度;同时分别计算G+ 组与G-组CSF中CRP与血清CRP的比值。结果　G+ 组、G-组血清CRP质量浓度明显高于对照组(均P <0 .0 1) ,G+ 组与G-组血清CRP质量浓度差异无显著性(P >0. 0 5 ) ,G-组CSF中CRP质量浓度明显高于G+ 组和对照组(均P <0 . 0 1) ,G+ 组与对照组CSF中CRP质量浓度差异无显著性(P>0 . 0 5 ) ;CSF中CRP与血清CRP比值G-组高于G+ 组(P <0 .0 1)。结论　G+ 脑膜炎CSF中CRP变化不明显,而G-脑膜炎CSF中CRP明显升高,CSF与血清CRP比值升高,其变化对化脓性脑膜炎病原菌的鉴别有一定的临床意义。     

Measurement of cerebrospinal fluid protein is unnecessary in children with leukemia

To determine the incidence and importance of abnormal cerebrospinal fluid (CSF) protein in children with acute leukemia, we performed a retrospective chart review. On 160 pediatric patients a total of 2,172 LPs were performed (median per patient = 15; range 1-38). Overall, 314 (14%) of CSF protein measurements were abnormal: 141 (7%) were abnormally low (<15 mg/dL) and 158 (7%) were abnormally high (>45 mg/dL). In no case did an abnormal CSF protein impact patient management. We conclude that routine measurement of CSF protein is not indicated in children with acute leukemia.     

细菌性脑膜炎患儿脑脊液一氧化氮变化的研究

目的观察细菌性脑膜炎患儿脑脊液一氧化氮(NO)的变化及地塞米松对其的影响.方法应用Griess法和氨基酸自动分析仪检测23例细菌性脑膜炎患儿脑脊液中NO代谢终产物--亚硝酸盐和NO前体--L-精氨酸的浓度,并将31例无神经系统疾病患儿的脑脊液作为对照组.结果(1)治疗前,细菌性脑膜炎患儿脑脊液亚硝酸盐浓度[(10.76±4.09)μnol/L]明显高于对照组[(2.69±1.20)μnol/L],差异有显著性(t1=10.41,P＜0.01);经治疗后,脑脊液亚硝酸盐浓度渐下降.脑脊液指标恢复正常后,亚硝酸盐浓度[(3.00±1.16)μmol/L]与对照组差异无显著性(t=1.24,P＞0.05).(2)23例细菌性脑膜炎患儿中,14例单用抗生素治疗,其余9例在抗生素治疗的基础上,加用地塞米松治疗.抗生素+地塞米松治疗组脑脊液亚硝酸盐浓度[(5.92±1.90)μnol/L]显著低于单用抗生素组[(8.86±3.50)μnol/L],差异有显著性(t=2.30,P＜0.05).(3)细菌性脑膜炎患儿治疗前脑脊液L-精氨酸浓度[(12±6)μmol/L]显著低于对照组[(17±8)μnol/L],差异有显著性(t＝2.29,P＜0.05).结论NO参与了细菌性脑膜炎的病理过程,而地塞米松能部分抑制NO的过度产生.     

脑脊液渗透浓度测定在小儿急性脑水肿治疗中的应用和意义

目的　探讨脑脊液渗透浓度监测在急性脑水肿患儿中的作用及其与预后的关系。方法　收集 5 6例诊断为急性脑水肿患儿的脑脊液标本共 115例次 ,同时采集血液做渗透浓度测定行相关分析。选择小儿正常脑脊液标本共 2 1例作为本方法测定的正常参考值。使用美国产微量渗透压仪 (Model 330 0 )测定渗透浓度。结果　① 2 1例小儿正常脑脊液参考值为 (2 84 8± 8 7)mmol/L ,5 6例急性脑水肿患儿共 115例次脑脊液标本渗透浓度范围 2 5 3～ 35 3mmol/L ;② 10例不同急性脑水肿患儿同一时间的血和脑脊液渗透浓度分别为 (2 92 2± 2 3 6 )mmol/L和 (2 90 4± 2 7 5 )mmol/L ,两者具有高度正相关 (r =0 933,P <0 0 1) ;③ 5例死亡患儿 (共 11例次 )的脑脊液渗透浓度为 (334 8± 16 5 )mmol/L ,与正常参考值比较差异有非常显著性意义 (P <0 0 1) ;当脑脊液渗透浓度超过 32 0mmol/L时 ,病死率明显增加 ;④结脑患儿治疗前脑脊液渗透浓度值为 (2 6 5 4± 11 1)mmol/L ,较正常参考值明显下降 ,差异有显著性意义 (P <0 0 5 ) ;经治疗后脑脊液渗透浓度上升至 (2 80 2± 15 9)mmol/L ,与治疗前比较差异有显著性意义 (P <0 0 5 )。结论　①脑脊液与血渗透浓度具有高度相关性 ,故临床上可用血液替代脑脊液进行渗透浓     

危重病患儿脑脊液和血液气体及酸碱变化的对比研究

目的　探讨危重病患儿脑脊液 (CSF)和血液气体及酸碱含量变化及其与疾病的关系。方法　 6 0例危重病患儿 [危重评分 <70分和 (或 )Glasgow昏迷评分≤ 8分 ]中 ,中枢神经系统 (CNS)疾病组 34例 ,非CNS疾病组 2 6例。同步检测 6 0例急性期CSF和动脉血pH、PO2 、PCO2 、HCO-3 等含量。结果　CSF中pH、PO2 、PCO2 、HCO-3 与血液相应指标变化呈正相关 (r =0 .348～ 0 .872 ,P <0 .0 5或0 .0 1)。CNS疾病组 ,CSF中pH、PO2 、PCO2 、HCO-3 分别为 7.10、5 2 .7mmHg、5 8.8mmHg和 15 .6 2mmol L ,与动脉血指标比较差异有显著性 (P <0 .0 1) ,其中CSF的PO2 比动脉血PO2 (平均 78.8mmHg)低 2 6 .3mmHg ;非CNS疾病组CSF的pH、PO2 、PCO2 、HCO-3 分别为 7.0 4、5 5 .4mmHg、5 9.2mmHg和16 .7mmol L ,与动脉血指标比较差异无显著性 (P >0 .0 5 )。两组疾病CSF中各指标比较差异无显著性(P >0 .0 5 )。结论　危重病患儿伴随有CSF酸碱指标的显著变化 ,并与血气指标呈正相关。当CNS疾病动脉血PO2 降低尚不明显时 ,脑组织可能已存在明显低氧状态。CSF气体及酸碱测定可对危重病患儿脑组织氧水平、酸碱状态的评估提供依据。     

Studies on the concentrations of chloramphenicol in the serum and cerebrospinal fluid of neonates,infants, and small children

The interactions between chloramphenicol, penicillin and phenobarbitone were investigated in 383 children (premature and neonate children, infants and small children). As expected, the chloramphenicol concentrations in the serum of the newborns was considerably higher than that of infants and small children with the same dosage of chloramphenicol. In the age group of the premature and newborn children and infants there were significantly higher total chloramphenicol concentrations with the chloramphenicol-penicillin combination than with chloramphenicol monotherapy. Addition of phenobarbitone to the combination significantly reduced the chloramphenicol concentrations in the neonates. Lowering of the serum chloramphenicol concentrations by phenobarbitone could not be statistically confirmed in the infant age group.Combinations of chloramphenicol with ampicillin, gentamycin or cephalosporin derivatives showed no influence on serum chloramphenicol concentrations.Transference of chloramphenicol from the serum to the cerebrospinal fluid was about twice as high in the acute inflammatory stage as when the meninges were no longer acutely diseased (60 and 30% respectively of the serum concentrations). The passage of chloramphenicol to the cerebrospinal fluid showed no dependence on age.

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Zusammenfassung In Untersuchungen an 383 Kindern (Früh- und Neugeborenen, Säuglingen und Kleinkindern) wurde die Wechselwirkung zwischen Chloramphenicol und Penicillin sowie Phenobarbital geprüft. Erwartungsgemäß lagen bei gleicher Chloramphenicoldosierung die Chloramphenicolkonzentrationen im Serum neugeborener Kinder erheblich über denen der Säuglinge und Kleinkinder. In der Altersklasse der Früh- und Neugeborenen sowie der Säuglinge traten unter Chloramphenicol-Penicillin-Kombination signifikant höhere Gesamtchloramphenicolkonzentrationen auf als bei Chloramphenicol-Monotherapie. Zugabe von Phenobarbital zu der Kombination verringerte bei Neugeborenen signifikant die Chloramphenicolkonzentrationen. Die Erniedrigung der Chloramphenicolserumkonzentrationen unter Phenobarbital konnte bei der Altersgruppe der Säuglinge nicht statistisch gesichert werden.Keinen Einfluß auf die Chloramphenicolserumkonzentrationen zeigten Kombinationen von Chloramphenicol mit Ampicillin, Gentamycin oder Cephalosporinderivaten.Der Übertritt von Chloramphenicol aus dem Serum in den Liquor war in der akuten Entzündungsphase etwa doppelt so hoch wie bei nicht mehr akut erkrankten Meningen (60 bzw. 30% der Serumkonzentrationen). Eine Altersabhängigkeit der Liquorpassage von Chloramphenicol konnte nicht gesehen werden.

     

Myelin basic protein in cerebrospinal fluid from children

Forty-one cerebrospinal fluid (CSF) specimens from children were investigated with a radioimmunoassay for their content of myelin basic protein (BP). Eight specimens were regarded as BP-positive (BP1.0 ng/ml). Twenty-nine were BP-negative and 4 could not be analyzed because of an excessive protein content. The BP-positive samples were from 6 children with evidence of severe acute brain damage leading to death in 5 cases: i.e., 2 term newborns with perinatal asphyxia, a 4 week-old child with severe convulsions, a 3 year-old boy with hypoxia due to laryngitis, and a 12 year-old girl with encephalitis. One preterm baby survived severe hypoxia and developed hydrocephalus shortly afterwards. We conclude that BP becomes detectable in CSF of newborns and older children under certain pathological conditions, and that the presence of BP in CSF may be associated with severe brain tissue destruction.Supported by Deutsche Forschungsgemeinschaft, SFB 33     

Ferritin in cerebrospinal fluid of patients with lymphoproliferative disorders

The ferritin concentration in cerebrospinal fluid (CSF) from children and three adults with lymphoproliferative disorders was determined. While these levels were normal in children without CNS involvement before treatment, they rose during induction therapy and remained high also during consolidation therapy. As the intensity of treatment decreased during the consolidation phase, CSF ferritin declined but did not reach pretreatment concentrations. After three years of maintenance therapy (without intrathecal injections) CSF ferritin was normal. CSF ferritin concentration does not reflect the stage of the disease but seems to correlate to the treatment, especially if this is administered intrathecally. In adults with CNS involvement, CSF ferritin showed no correlation to the CSF cell count, the degree of CNS involvement or to the treatment. It is of little use in demonstrating the spread of the malignant process to the CNS.