脑脊液腺苷脱氨酶、乳酸、C反应蛋白、乳酸脱氢酶检查在小儿颅内感染鉴别诊断中的价值

目的探讨急性期脑膜炎患儿的脑脊液腺苷脱氨酶(ADA)、乳酸(LA)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)活性变化对不同类型脑膜炎的鉴别诊断意义。方法应用全自动生化分析仪检测病毒性脑膜炎(26例)、结核性脑膜炎(20例)、化脓性脑膜炎(21例)病人的脑脊液中ADA、LA、CRP、LDH的含量,并与对照组(同期住院的非中枢神经系统病变的外科手术患儿)进行比较。结果化脓性脑膜炎组、结核性脑膜炎组脑脊液ADA、LA、CRP、LDH明显高于对照组(P<0.05),而病毒性脑膜炎组与对照组差异无统计学意义(P>0.05);化脓性脑膜炎组脑脊液LA、CRP、LDH明显高于结核性脑膜炎组及病毒性脑膜炎组(P<0.05);结核性脑膜炎组脑脊液ADA、LA、CRP、LDH明显高于病毒性脑膜炎组(P<0.05)。结论脑脊液ADA、LA、CRP、LDH测定有助于不同类型脑膜炎的早期诊断。     

早期血乳酸监测在老年社区获得性肺炎中的临床价值

目的研究早期乳酸和乳酸清除率监测对老年社区获得性肺炎（CAP）患者预后的评估价值。方法收集我院急诊科入院时血乳酸升高老年CAP患者55例,根据预后分为死亡组和存活组,比较两组患者的乳酸水平、6 h和24 h乳酸清除率、机械通气、急性生理学及慢性健康状况评价Ⅱ（acute physiology and chronic health evaluationⅡ,APACHEⅡ）评分等指标的区别;把55例乳酸升高CAP患者根据乳酸清除率≥10%和〈10%分为两组,比较两组病死率和APACHEⅡ评分等指标的区别。结果死亡组与存活组患者比较,在入院乳酸值、6 h和24 h乳酸清除率有显著性差异（P〈0.05）;6 h乳酸清除率≤10%的老年CAP患者病死率明显大于乳酸清除率≥10%患者（P〈0.01）。结论入院时乳酸值和6 h乳酸清除率是评价老年CAP患者预后的良好指标。6 h清除率≤10%时提示患者预后较差。     

自然杀伤细胞在细菌性肺炎中的免疫效应作用

自然杀伤细胞是人体固有免疫系统中一类十分重要的细胞,它无需预先致敏就具有杀伤作用,构成了抗击病原微生物的第一道防线.近年来随着对自然杀伤细胞表面受体及其特异性配体的认识,自然杀伤细胞在抗感染方面的研究取得了重大进步,自然杀伤细胞不仅可以通过穿孔素、自然杀伤细胞毒因子和肿瘤坏死因子发挥杀伤作用,而且可以通过分泌多种细胞因子发挥重要免疫调节作用.本文对自然杀伤细胞在细菌性肺炎中的免疫效应加以阐述.     

平衡超滤对体外循环婴幼儿血清乳酸水平的影响

目的探讨平衡超滤对体外循环（ECC）婴幼儿血清乳酸的影响。方法选取36例室间隔缺损合并肺动脉高压的婴幼儿患者，随机分为观察组（应用平衡超滤）和对照组（仅给常规剂量的速尿），每组18例。分别抽取患儿术前、ECC前、ECC30min、ECC60min、ECC停止1h、术后24h及术后48h的动脉血测血清乳酸水平。结果对照组从麻醉开始到ECC结束，婴幼儿动脉血乳酸水平逐渐升高，ECC结束后达最高，之后逐渐下降；观察组患儿ECC中乳酸水平亦上升，但上升不明显。结论平衡超滤技术可显著降低体外循环手术婴幼儿围术期血清乳酸水平。     

婴幼儿细菌性肺炎血清降钙素原动态检测的指导意义

目的婴幼儿细菌性肺炎通过血清降钙素原(PCT)的动态监测,分析感染程度以及预后评价。方法收集240例婴幼儿细菌性肺炎患儿。分别在入院时,治疗72 h后进行两次PCT检查。结果入院时患儿细菌感染程度血清随着PCT水平增高而增加,PCT四个等级水平重症肺炎比率分别为8.33%,21.7%,43.1%,55.6%。治疗72 h复查PCT下降率《20%和PCT下降率》40%的患儿并发症发生率为20.3%,57.9%。(均P<0.05)。结论 PCT水平的高低有助于诊断感染的程度,以及预测并发症发生几率。PCT连续监测在单位时间内下降的速度越慢婴幼儿预后效果越差。     

脑脊液检测项目在结核性脑膜炎诊断应用中的若干进展

脑脊液检测项目在结核性脑膜炎诊断应用中的若干进展王巍庄玉辉结核性脑膜炎（结脑）仍是威胁人类生命的主要肺外结核病之一，预后的关键在于早期诊断和及时治疗。由于不典型病例增多，脑脊液（ＣＳＦ）的实验室检测十分重要。现就ＣＳＦ检测项目在结脑诊断中应用的若干进...     

降钙素原与乳酸在老年社区获得性肺炎患者预后评估中的应用

目的研究降钙素原(PCT)与乳酸对老年社区获得性肺炎患者的病情和预后的评估作用。方法 118例老年社区获得性肺炎患者,入院后给予PCT、乳酸等检查,并给予肺炎严重指数(PSI)评分。分别比较重症与非重症肺炎、死亡组和存活组PCT、乳酸和PSI的区别;分析PCT、乳酸与PSI的相关性。结果重症肺炎患者乳酸、PCT和PSI评分均大于非重症患者,死亡组乳酸、PCT和PSI评分均大于存活组(P<0.05);乳酸、PCT与PSI评分呈正相关(r=0.63,0.65,P<0.05)。结论 PCT和乳酸对老年社区获得性肺炎患者的预后和病情有评估作用,PCT和乳酸升高提示患者预后差。     

人工脑脊液置换在结核性脑膜炎治疗中的应用

目的观察人工脑脊液置换联合鞘内给药对结核性脑膜炎的治疗效果。方法将68例结核性脑膜炎患者随机分为观察组31例和对照组37例。在常规治疗的基础上观察组行人工脑脊液置换并鞘内给药;对照组行生理盐水置换联合鞘内给药治疗。治疗后4、8周时比较两组脑脊液生化指标和颅内压,10个月后评定治疗效果。结果观察组脑脊液各项生化指标及颅内压改善情况明显优于对照组（P〈0.05）,在降低颅内压和白细胞方面尤为显著（P〈0.01）;观察组治愈率与总有效率均明显高于对照组（P均〈0.05）。结论人工脑脊液置换联合鞘内给药可进一步提高结核性脑膜炎的治疗效果,优化结核性脑膜炎的治疗方案。     

环介导等温扩增技术在检测细菌性肺炎常见致病菌中的应用

目的 应用环介导等温扩增(LAMP)方法对肺炎患者痰液常见致病菌进行核酸检测,研究LAMP方法在细菌性肺炎病原学诊断中的价值.方法 抽提75例肺炎患者痰液细菌DNA,根据肺炎常见8种致病细菌设计引物,应用LAMP技术扩增DNA,实时检测样本荧光信号,对定量结果应用不同界值进行定性分析,并分别与痰培养结果进行比较.结果 ...     

NLR PCT和乳酸水平在社区获得性肺炎危险度分层中的预测价值

［摘要］　目的　探讨中性粒细胞计数/淋巴细胞计数（NLR）、血清降钙素原（PCT）和乳酸水平在社区获得性肺炎（CAP）患者疾病危险度分层评估中的价值。方法　选择2018年1月至2019年12月在该院诊断为CAP的282例老年患者作为研究对象,将患者按CURB65评分≤2分为低风险组（192例）,CURB65评分>2分为高风险组（90例）。采集血样后行血细胞计数,并计算NLR值,同时检测患者外周血PCT和乳酸水平。采用受试者工作特征（ROC）曲线比较NLR、PCT和乳酸诊断CAP疾病危险度分层的效能。结果　低风险组NLR、PCT和乳酸的检测值低于高风险组,差异有统计学意义（P<0.05）。NLR判别高风险CAP（重症肺炎）的截断值为13.10,其曲线下面积（AUC）为0.88。血清乳酸预测高风险CAP的截断值为2.05 mmol/L,其AUC为0.89。PCT预测高风险CAP的截断值为1.25 ng/ml,其AUC为0.95,灵敏度和特异度分别为84.40%和94.34%,约登指数为0.79。3种指标均能较好地预测CAP患者疾病危险度,以PCT为最佳预测独立因子。结论　NLR、PCT和乳酸是预测CAP病情分层的较好生物标志物,以PCT为最佳。     

Elevated cerebrospinal fluid kynurenic acid levels in patients with tick-borne encephalitis

Abstract. Holtze M, Mickiené A, Atlas A, Lindquist L, Schwieler L (Karolinska Institutet, Stockholm; Lithuanian University of Health Sciences, Kaunas, Lithuanian; Karolinska Institutet, Karolinska University Hospital, Huddinge; Karolinska Institutet, Karolinska University Hospital, Solna, Sweden). Elevated cerebrospinal fluid kynurenic acid levels in patients with tick‐borne encephalitis. J Intern Med 2012; 272: 394–401. Background. Kynurenic acid (KYNA) is a neuroactive metabolite of tryptophan that is thought to regulate cognitive functions. Previous studies have shown that levels of KYNA increase during virus infection and that this metabolite interacts with the immune system. Objective. The aim of the study was to investigate whether patients with tick‐borne encephalitis (TBE), a viral infectious disease associated with long‐term cognitive impairment, have increased levels of KYNA in the cerebrospinal fluid (CSF). Methods. CSF KYNA was analysed using high‐performance liquid chromatography in 108 patients with TBE and 52 age‐matched controls. Patients were classified according to the severity of TBE: mild (47%), moderate (44%) or severe (9%). Results. Concentrations of CSF KYNA were considerably higher in patients with TBE (5.3 nmol L^?1) than in control subjects (0.99 nmol L^?1). KYNA concentration in the CSF varied greatly amongst individuals with TBE and increased (P < 0.05) with the severity of disease. Conclusions. This is the first study to demonstrate increased levels of CSF KYNA in patients with TBE. The importance of brain KYNA in both immune modulation and neurotransmission raises the possibility that abnormal levels of the compound in TBE might play a part in the pathophysiology of the disease. A detailed knowledge of endogenous brain KYNA during the course of CNS infection might yield further insights into the neuroimmunological role of the compound and may also provide new pharmacological approaches for the treatment of cognitive symptoms.     

Serial measurement of anti-interleukin-8 IgG autoantibody in cerebrospinal fluid of infants with bacterial meningitis

We serially measured concentrations of interleukin (IL)-8 and anti-IL-8 IgG autoantibody in cerebrospinal fluid of infants with bacterial meningitis, and also measured these concentrations in cerebrospinal fluid obtained from infants without meningitis on admission. We have reported that the IL-8 concentration in cerebrospinal fluid of infants with purulent meningitis rapidly decreases after the initiation of therapy. Thus, in the present study, the IL-8 concentration in infants with purulent meningitis only before the initiation of therapy was significantly higher compared with that in infants without meningitis. However, the concentration of anti-IL-8 IgG autoantibody was still high after the initiation of therapy. The concentration of anti-IL-8 IgG autoantibody was significantly higher compared with that in infants without meningitis until the 15th day after the initiation of therapy. The time lag between the decrease of IL-8 and anti-IL-8 IgG autoantibody demonstrated in the present study could be used to indicate the past presence of a large amount of IL-8, even if the IL-8 concentration was already low.     

Adenosine deaminase levels in cerebrospinal fluid in tuberculosis and bacterial meningitis.

Adenosine deaminase activity was measured in cerebrospinal fluid of patients with confirmed tuberculous and bacterial meningitis. The values were compared with those of control subjects without meningitis. A statistically significant increase in the level of this enzyme was noted in the two types of meningitis, but no definite demarcation in the levels was observed between the two types. Therefore increases in adenosine deaminase activity may not be of such diagnostic significance as reported elsewhere.     

Measurement of lactic acid in cerebrospinal fluid of patients with infections of the central nervous system

The concentration of lactic acid in cerebrospinal fluid (CSF) was determined by gas-liquid chromatography in 205 samples of CSF from 97 patients with or without infections of the central nervous system. Patients without infection or those with nonbacterial (presumably viral) meningitis consistently had low concentrations of lactic acid in CSF (i.e., less than or equal to 35 mg/100 ml), whereas patients with bacterial or tuberculosis meningitis consistently had concentrations of lactic acid in CSF of greater than 35 mg/100 ml. There was no overlap in concentrations of lactic acid between these two groups. Further, lactic acid concentrations in CSF from patients partially treated for meningitis were generally greater than 35 mg/100 ml through the third day of therapy and, thereafter, progressively declined to less than 20 mg/100 ml by the seventh to 10th day of therapy. Relapse of bacterial infection was consistently documented by a recurrence of an increased concentration of lactic acid in CSF. Preliminary experience with determination of the concentration of lactic acid in CSF suggests that it may be useful in distinguishing bacterial (with or without positive cultures) and tuberculous meningitis from meningitis due to nonbacterial causes.     

Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: the differential diagnostic importance of cerebrospinal fluid lactic acid levels

Listeria monocytogenes is a common cause of bacterial meningitis in elderly patients and in those with impaired cellular immunity. The most common central nervous system infection caused by L. monocytogenes is acute bacterial meningitis; meningoencephalitis is uncommon and encephalitis is rare. Early diagnosis of L. monocytogenes meningitis is difficult because only 50% of cerebrospinal fluid (CSF) Gram stains are negative. L. monocytogenes is one of the few central nervous system pathogens associated with red blood cells in the CSF. When L. monocytogenes presents as encephalitis with red blood cells in the CSF, the clinical presentation mimics most closely herpes simplex virus (HSV)-1 encephalitis. Because the therapies for L. monocytogenes and HSV-1 are different, early diagnostic differentiation is clinically important. The CSF lactic acid is the best way to rapidly differentiate between these two entities; the CSF lactic acid level is elevated in L. monocytogenes but is not elevated in HSV-1 encephalitis. The case presented is an elderly man with chronic lymphocytic leukemia who presented with encephalitis. Advanced age and chronic lymphocytic leukemia predispose him to a wide variety of pathogens, but the rapidity and severity of his clinical presentation made L. monocytogenes and HSV-1 encephalitis the most likely diagnostic possibilities. The CSF Gram stain was negative, but the elevated CSF lactic acid levels with encephalitis and red blood cells in the CSF indicated L. monocytogenes as the most likely pathogen. We present a case of L. monocytogenes encephalitis mimicking HSV-1 encephalitis. While receiving ampicillin therapy, the patient remained unresponsive for more than 1 week and then suddenly regained consciousness and recovered without neurologic sequelae.     

Interleukin levels in cerebrospinal fluid from children with neurocysticercosis.

No information about the levels of pro-inflammatory interleukins has been described in children with neurocysticercosis (NCC). The levels of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-5, IL-6, and IL-12 in the cerebrospinal fluid from children with NCC were determined by enzyme-linked immunosorbent assay (ELISA). Twelve children with NCC, six with active and six with inactive disease, and six children without NCC were studied. TNF-alpha was undetectable in CSF from controls and five children with inactive NCC, whereas the levels were significantly higher (median 22.1 pg/ml; P = 0.008) in all children with active NCC. Levels of IL-6 were low in active and inactive NCC patients but two subjects with active subarachnoid disease had high levels. IL-5 and IL-12 were not detected. This study shows that high levels of TNF-alpha are present in CSF from children with active NCC. IL-6 levels are higher when infection occurs in the subarachnoid space.