Concentrations of cefoperazone in cerebrospinal fluid during bacterial meningitis

Cefoperazone was administered to 15 patients with bacterial meningitis before lumbar punctures were performed. Patients received one of the following three dosage regimens before collection of cerebrospinal fluid (CSF): one dose of 50 mg/kg (maximum, 2 g; group I), one dose of 100 mg/kg (maximum, 4 g; group II), three doses of 100 mg/kg each every 8 h (maximum, 4 g each dose; group III). Of 44 CSF samples, 26 had detectable cefoperazone levels (59%); drug concentrations in CSF ranged from less than 0.8 to 11.5 micrograms/ml (median, 1.97 micrograms/ml). Although the percentage of patients with detectable cefoperazone levels in CSF was higher in group III (69%) than in group II (64%) or group I (50%), the differences were not statistically significant; however, the mean drug concentration in CSF in group I (1.53 micrograms/ml) was significantly lower than that in group III (3.1 micrograms/ml). A high protein concentration in CSF (as an indicator of meningeal inflammation) correlated best with high cefoperazone concentrations in CSF. These findings differ from previous investigations of cefoperazone penetration into CSF; however, cefoperazone may not penetrate reliably into CSF and therefore may not be an optimal candidate drug for the treatment of bacterial meningitis.     

The clinical value of rapid C-reactive protein measurement in cerebro-spinal fluid

C-Reactive protein (CRP) has been measured in 90 consecutive CSF specimens using both latex agglutination and an immunoradiometric assay (IRMA). In the 60 CSF specimens otherwise normal by standard biochemical and microbiological criteria, the median CRP level was 32 micrograms/l (95% confidence limits, 0-108 micrograms/l) and in the remaining abnormal specimens the median level was 176 micrograms/l (95% confidence limits, 110-325 micrograms/l, p = 0.001). C-Reactive protein was detected by a commercial latex agglutination kit at a level of approximately 120 micrograms/l and all significant CNS bacterial infections were positive (7 bacterial meningitis, 2 infected shunts). In addition, viral encephalitis, extensive intracranial malignancy and subarachnoid haemorrhage gave positive agglutinations, but not in every case. A further nine specimens with a minor elevation of CRP level were detected by IRMA (median 76 micrograms/l), but this was of little practical significance. We have shown that normal CSF C-reactive protein levels are very low and we conclude that latex agglutination set at a sensitivity of 120 micrograms/l, although only semi-quantitative, is a rapid and useful method to assess CSF C-reactive protein in routine clinical practice and, when positive, is strong supporting evidence for bacterial infection.     

Soluble triggering receptor expressed on myeloid cells 1: a biomarker for bacterial meningitis

OBJECTIVE: To evaluate whether soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in CSF can serve as a biomarker for the presence of bacterial meningitis and outcome in patients with this disease. DESIGN: Retrospective study of diagnostic accuracy. SETTING AND PATIENTS: CSF was collected from 92 adults with community-acquired bacterial meningitis who participated in the prospective Dutch Meningitis Cohort Study; 8 patients with viral meningitis and 9 healthy control subjects. RESULTS: CSF sTREM-1 levels were higher in patients with bacterial meningitis (median 82 pg/ml, range 0-988) than in those with viral meningitis (0 pg/ml, 0-48) and controls (0 pg/ml, 0-36). The diagnostic accuracy of sTREM-1 in discriminating between patients with and without bacterial meningitis, expressed as the area under the receiver operating characteristic curve, was 0.82. At a cutoff level of 20 pg/ml the sensitivity was 0.73 and specificity 0.77. In patients with bacterial meningitis CSF sTREM-1 levels were associated with mortality (survivors, median 73 pg/ml, range 0-449 pg/ml; nonsurvivors, 15 pg/ml, 0-988). CONCLUSIONS: Measuring sTREM-1 in CSF may be a valuable new additional approach to accurately diagnose bacterial meningitis and identify patients at high risk for adverse outcome. Therefore a prospective study of sTREM-1 as a biomarker in bacterial meningitis is needed.     

Recent survey of infectious meningitis in adults: review of laboratory findings in bacterial, tuberculous, and aseptic meningitis.

Infectious meningitis in adults was reviewed to establish the frequency of meningitis due to each causative agent and to reexamine the laboratory parameters that help to distinguish aseptic, bacterial, and mycobacterial meningitis. Aseptic meningitis occurred 2.2 times more often than bacterial and mycobacterial meningitis combined. The most common nonviral causative agent was the pneumococcus (23 cases) followed by the tubercle bacillus (11 cases) and the meningococcus (5 cases). Cerebrospinal fluid (CSF) Gram stain was the most useful study to rule in a bacterial cause: 89% of cases of bacterial meningitis had a positive initial Gram stain. Hyponatremia occurred in 73% of cases of tuberculous meningitis; hyponatremia combined with a negative Gram stain was highly suggestive of a tuberculous cause. One third of all patients with tuberculous and aseptic meningitis had a predominance of neutrophils in the CSF. No patient with aseptic meningitis had a CSF while count higher than 2,800 cells/cu mm or a CSF protein value higher than 250 mg/100 ml. Other reviews confirm this if cases due to lymphocytic choriomeningitis (LCM) are excluded. One patient with tuberculous meningitis in this series, and none of those cases reviewed, had a CSF white count higher than 1,200 cells/cu mm. Only 3.7% of the patients with aseptic meningitis had hypoglycorrhachia. Series reporting exclusively disease due to mumps and LCM have a higher frequency of hypoglycorrhachia.     

Cefotaxime in treatment of meningitis and ventriculitis? Evaluation of drug concentrations in human cerebrospinal fluid

In three groups of patients levels of cefotaxime in serum and cerebrospinal fluid were determined. Therapeutic value and efficacy are discussed in meningitis patients. Nine concentrations of cefotaxime in lumbar and ventricular CSF out of 19 in a group of seven neurosurgical patients with mild to moderate impairment of the blood-CSF-barrier were higher than 0.5 g/ml. In seven determinations in a second group of six patients with no or very little dysfunction of the blood-cerebrospinal-fluid barrier only twice cefotaxime was not detectable in lumbar CSF. Concentrations of cefotaxime in 25 determinations of lumbar or ventricular CSF in six patients with bacterial meningitis ranged from 1.1 g/ml to 19.2 g/ml. Treatment with cefotaxime alone was successful in a patient withE. coli meningitis and ventriculitis after infection of a ventriculo-atrial shunt and in another patient with pneumococcal meningitis and penicillin allergy. The other four patients with bacterial meningitis were treated successfully by antibiotics including cefotaxime.     

Serum procalcitonin monitoring for differential diagnosis of ventriculitis in adult intensive care patients

The objective of our study was to assess the value of serum procalcitonin (PCT) monitoring in the differential diagnosis of ventriculitis in adult intensive care (ICU) patients. We analyzed 15 consecutive patients with ventriculitis in which a ventricular catheter had been inserted and contrasted these data with the observations in 10 patients with community-acquired bacterial meningitis. Cerebrospinal fluid (CSF) and blood samples were collected daily to assess serum PCT, C-reactive protein (CRP) and CSF leukocyte count. PCT levels were normal or slightly elevated in patients with ventriculitis with either positive or negative CSF bacterial culture but elevated in patients with bacterial meningitis. A PCT cut-off value of 1.0 ng/ml or more showed a specificity of 77% and a sensitivity of 68% for ventriculitis with positive CSF bacterial culture. Serum PCT levels reflected more accurately the time phases of disease during therapy. We conclude that the monitoring of serum PCT alone is not helpful for the differential diagnosis of ventriculitis, in contrast to that of bacterial meningitis. The value of PCT as an additional marker with which to assess the efficacy of therapy in ventriculitis is suggested, but requires further assessment.     

Cerebrospinal fluid lactate in 78 cases of adult meningitis

In a retrospective study of 78 cases of adult meningitis, the CSF lactate was measured on the first spinal tap (ST); 25 had a bacterial meningitis, 28 a viral meningitis; 22 other cases had been on antibiotics prior to admission; 3 cases had meningitis of rare aetiology. The median CSF lactate level among the 25 bacterial cases amounted to 13.6 mmol/l (range: 3.5-24.5) whereas it remained low in the 28 viral cases: 2.7 mmol/l (range: 1.4-4.2). These differences are highly significant. The comparison of the CSF lactate level with the other tests routinely performed showed that the CSF lactate level had the highest sensitivity, specificity and predictive values. The CSF lactate level on the first ST had no prognostic value, but a rapid decrease of the CSF lactate during the treatment is indicative of good prognosis. Among the pretreated cases, a high lactate level could be an indication that bacteria were the causal agents. In conclusion, the measurement of the CSF lactate, quickly performed and inexpensive, is worth performing when a meningitis is suspected, as it appears to be the best way of distinguishing bacterial from non-bacterial meningitis.     

Cefotaxime diffusion into cerebrospinal fluid of children with meningitis.

Cefotaxime diffused consistently and in therapeutic levels into the cerebrospinal fluid (CSF) of 13 children successfully treated for bacterial meningitis. CSF cefotaxime levels early (6.0 micrograms/ml) and late (1.2 micrograms/ml) in treatment were severalfold the MBCs for the infecting organisms. After a single 40-mg/kg dose to each of five infants with ventriculostomies, mean CSF levels of cefotaxime were 6.4, 5.7, and 4.5 micrograms/ml at 2, 4, and 6 h, respectively.     

CSF alpha 2-macroglobulin and C-reactive protein as aids to rapid diagnosis of acute bacterial meningitis

alpha 2-Macroglobulin (AMG) and C-reactive protein (CRP) levels in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis have been analyzed by a rate nephelometric method to determine if these acute phase proteins can aid in differentiation of bacterial from aseptic meningitis. The mean CSF concentrations of AMG and CRP were 15 and 3.5 times greater, respectively, in the bacterial compared to the aseptic meningitis group. Also, the range of AMG levels showed minimal overlap between the two groups. The elevated levels of the proteins persisted after CSF cultures became negative. Quantitation of specific acute phase proteins in CSF may assist the differentiation of bacterial from aseptic meningitis.     

脑脊液及血清PCT、CD64、CRP在脑膜炎患儿中的鉴别诊断价值

目的探讨脑脊液及血清降钙素原(PCT)、CD64、C反应蛋白(CRP)在脑膜炎患儿中的鉴别诊断价值。方法以该院收治的120例急性脑膜炎患儿为研究对象,患儿在入院24 h及治疗7 d后,均接受腰椎穿刺检查。比较细菌性脑膜炎患儿和病毒性脑膜炎患儿脑脊液和血清中PCT、CD64、CRP水平。结果依据脑脊液、血清检测结果,120例患儿中细菌性脑膜炎55例(细菌性脑膜炎组),病毒性脑膜炎65例(病毒性脑膜炎组);入院后24 h内,细菌性脑膜炎组患儿脑脊液、血清PCT、CD64及CRP水平均明显高于病毒性脑膜炎组(P<0.05);治疗7 d后,两组患儿PCT、CD64及CRP水平比较差异无统计学意义(P>0.05)。结论脑脊液及血清PCT、CD64及CRP能够鉴别细菌性脑膜炎及病毒性脑膜炎,有助于指导临床合理用药及预后判断。     

Penetration of aztreonam into cerebrospinal fluid and brain of noninfected rabbits and rabbits with experimental meningitis caused by Pseudomonas aeruginosa.

This study examined the penetration of aztreonam into the cerebrospinal fluid (CSF) and brain in noninfected rabbits and rabbits with experimental meningitis caused by Pseudomonas aeruginosa. Animals received either 600 or 1,200 mg of aztreonam administered intravenously over 6 h. Aztreonam did not readily enter the CSF in the absence of meningitis. In noninfected animals, mean concentrations in the CSF ranged from 1.1 to 3.0 micrograms/ml with the 600-mg dose and from 2.3 to 4.7 micrograms/ml with the 1,200-mg dose. In contrast, mean concentrations of aztreonam in the CSF were significantly higher (P less than 0.01) at each sampling time in rabbits with experimental meningitis caused by P. aeruginosa. They ranged from 10.2 to 14.6 micrograms/ml with the 600-mg dose and from 29 to 40 micrograms/ml with the 1,200-mg dose. Although concentrations in the brain measured at 6 h tended to be higher in infected rabbits, this difference was not statistically significant. Aztreonam therapy produced a substantial decline in CSF bacterium counts over 6 h: mean CSF counts decreased 2.4 log10 CFU/ml in the 600-mg dose group and 3.0 log10 CFU/ml in the 1,200-mg dose group. The results of this study suggest that aztreonam may be useful in the therapy of meningitis caused by P. aeruginosa.     

Clinicopharmacological evaluation of amoxicillin and probenecid against bacterial meningitis.

Forty-three infants and children with bacterial meningitis were treated intravenously with 200 mg of amoxicillin sodium per kg per day for 10 days. (Patients were initially treated with ampicillin and chloramphenicol until the bacterial etiology was defined.) Patients were randomly treated with amoxicillin only or with amoxicillin and four doses of probenecid (10 mg/kg per dose) orally every 6 h for 24 h before the lumbar puncture at day 10. Serum and cerebrospinal fluid (CSF) were obtained on days 1, 5, and 10 of therapy for antibiotic assay. The mean peak serum concentration of amoxicillin of 49.2 micrograms/ml was increased to 61.4 micrograms/ml in patients who received probenecid. The half-life in serum (1.5 h) and area under the curve with probenecid (112.5 micrograms/ml-h) were increased compared with those of amoxicillin alone (1.3 h and 82.2 micrograms/ml-h). The mean peak CSF concentrations on days 1 and 5 were similar, but day 1 concentrations remained between 2.0 micrograms/ml and 5.0 micrograms/ml throughout the 4 h after a dose, whereas the day 5 values decreased at the same decay rate as that in serum. All CSF concentrations were lower on day 10, but patients receiving probenecid had peak values occurring at 1 hr rather than at 0.5 h, and levels were significantly greater at 1 and 2 h after a dose. There were no deaths and patients responded well to treatment.     

血清PCT检测在小儿急性细菌性脑膜炎及病毒性脑炎鉴别诊断中的应用

目的观察分析血清降钙素原(PCT)在小儿急性细菌性脑膜炎与病毒性脑膜炎鉴别诊断中的应用及其灵敏度与特异度。方法选取164例细菌性脑膜炎患儿与98例病毒性脑膜炎患儿及60例健康体检儿为研究对象,采用电化学发光免疫检测血清PCT、白细胞计数(WBC)、红细胞沉降率(ESR)及C反应蛋白(CRP),分析两组患者实验室检查结果、PCT检测结果分布、灵敏度及特异度。结果细菌性脑膜炎患儿的PCT、CRP、WBC检查结果均高于病毒性脑膜炎患儿。而阳性率比较细菌组PCT、WBC阳性率高于对病毒性脑膜炎组,两组PCT检查分布构成比较有显著差异(χ2=16.151,P0.01)。PCT检查鉴别诊断病毒性脑膜炎的灵敏度为97.6%(160/164),特异度为95.0%(57/60),误诊率为3.1%(7/224)。PCT检查鉴别诊断细菌性脑膜炎的灵敏度为98.0%(96/98),特异度为96.7%(58/60),误诊率为2.5%(4/158)。结论血清PCT作为小儿急性细菌性脑膜炎与病毒性脑膜炎的鉴别诊断指标准确性良好,结合CRP、WBC、ESR等联合鉴别诊断能够在早期快速给予准确的病原体诊断,从而提高临床治疗的针对性,减少抗菌药物滥用情况的发生,值得临床推广应用。     

脑脊液T-SPOT检测在结核性脑膜炎诊断中的临床应用价值

目的 探讨脑脊液结核斑点试验(T-SPOT)检测在结核性脑膜炎临床诊断中的价值,为结核性脑膜炎早期快速诊断提供实验依据。方法 对兰州军区兰州总医院221例脑脊液标本进行筛查,实验组选取脑脊液淋巴细胞计数大于100×10⁶/L或者高度怀疑脑膜炎患者淋巴细胞计数大于50×10⁶/L的82例脑脊液标本进行T-SPOT实验检测,统计分析患者临床诊断、脑脊液检测指标、血清PCT结果,对照组选取100例非结核性脑膜炎患者进行ROC曲线分析。结果 脑脊液结核斑点试验检测在结核性脑膜炎患者中的阳性率为64.63%(53/82),敏感度为98.11%,特异度为100%; 结核性脑膜炎患者脑脊液淋巴细胞计数、脑脊液蛋白、脑脊液葡萄糖、脑脊液氯离子值和血清PCT的ROC曲线下面积(AUC)分别为0.996,0.965,0.109,0.061和0.392,且结核性脑膜炎患者脑脊液淋巴细胞计数和脑脊液蛋白的均值分别为323.88±198.76个/L,1 478.2±778.64 mg/L。结论 脑脊液结核斑点试验检测在结核性脑膜炎患者中具有较高的阳性率、敏感度和特异度,可用于结核性脑膜炎的早期快速诊断。     

基于肽抗原的间接酶联免疫吸附法检测抗水通道蛋白4抗体在神经精神狼疮中的临床意义

目的：建立抗水通道蛋白4（AQ-4）抗体的检测方法,评估抗AQ-4抗体在神经精神狼疮（NPSLE）中的临床意义。方法：用3段AQ-4细胞外肽段包板,建立基于肽抗原的间接酶联免疫吸附（ELISA）检测方法,检测49例健康人、54例其他风湿病患者（32例多肌炎/皮肌炎,10例干燥综合征和12例类风湿关节炎患者）、105例系统性红斑狼疮（SLE）患者和103例NPSLE患者的血清中的抗AQ-4抗体;检测22例非风湿病患者、31例SLE患者、96例NPSLE、27例合并结核感染的SLE患者和8例隐球菌脑膜炎患者的脑脊液标本中抗AQ-4抗体。结果：以健康人（对照组）的平均光密度（OD）＋3标准差（SD）为临界值,血清标本阳性率在其他风湿病组为1.8%（1/54）;SLE组为14.3%（15/105）;NPSLE组为22.3%（23/103）。脑脊液标本阳性率在对照组为0%;SLE组为12.9%（4/31）;NPSLE组为29.2%（28/96）;SLE合并结核性脑膜炎者为37%（10/27）;SLE合并隐球菌脑膜炎者为0%（0/8）。SLE组合并NPSLE组患者的血清和脑脊液中的抗AQ-4抗体显著增加（P〈0.01）,SLE组血清和脑脊液中的抗AQ-4抗体水平相似（P〉0.05）。NPSLE组脑脊液中的抗体检出率（29.2%）较血清中抗体检出率（22.3%）增高（P〈0.01）。在SLE合并TB组的脑脊液中,抗AQ-4抗体的检出显著增高（P〈0.01）。结论：抗AQ-4抗体在SLE和NPSLE患者的血清和脑脊液中显著升高,尤其是脑脊液中。SLE合并结核性脑膜炎患者的抗AQ-4抗体显著升高,提示抗AQ-4抗体是狼疮合并结核性脑病的易患因素。     

Gentamicin penetration into cerebrospinal fluid in experimental Haemophilus influenzae meningitis.

We studied the effect of meningitis and the method of parenteral gentamicin administration (intramuscular injection, a 30-min intravenous infusion, or intravenous bolus administration) on achievable concentrations of drug in cerebrospinal fluid (CSF). In normal animals, only intravenous bolus administration of 2 to 8 mg/kg produced a gentamicin concentration of greater than 0.1 microgram/ml in CSF in some animals. All CSF samples contained less than the limit of detection (0.1 microgram/ml) after the intramuscular administration of 6 mg/kg. In animals with meningitis, gentamicin penetration into cisternal CSF was increased significantly after a bolus administration of 6 mg/kg (mean, 0.197 +/- 0.063 microgram/ml in normal animals versus 1.68 +/- 0.38 micrograms/ml in animals with meningitis; P less than 0.01). In meningitic animals that received 6 mg/kg as an intravenous bolus, lumbar CSF had the highest maximum concentration (4.25 +/- 1.08 micrograms/ml), in comparison with ventricular CSF (3.10 +/- 0.66 micrograms/ml). The gentamicin concentration in cisternal CSF decreased more slowly than it did in serum (elimination half-life, 238.70 +/- 64.56 min in cisternal CSF versus 82.73 +/- 2.91 min in serum), yielding a relative increase in the percentage of penetration. We conclude that maximum penetration by gentamicin into CSF occurs after intravenous bolus administration and that the maximum concentration occurs in lumbar CSF.     

Penetration of Amoxicillin into Cerebrospinal Fluid

The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 μg/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 μg/ml at 1.5 h and from 2.6 to 27.0 μg/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.     

Accuracy and Test Characteristics of Ancillary Tests of Cerebrospinal Fluid for Predicting Acute Bacterial Meningitis in Children with Low White Blood Cell Counts in Cerebrospinal Fluid

Objectives: To determine whether ancillary tests of cerebrospinal fluid (CSF), specifically, the total protein concentration, glucose concentration, and percent neutrophils, provide information for diagnosing acute bacterial meningitis among children with low white blood cell (WBC) count in CSF. Methods: The authors retrospectively reviewed CSF from children aged 1 month to 18 years undergoing lumbar puncture at Children's Hospital in Boston from 1993 to 1999. Data were supplemented with CSF test results obtained from children with 0–30 WBCs/mm³ in CSF diagnosed with acute bacterial meningitis at the same institution from 1984 to 1992. For each test, the incremental value of ancillary tests was estimated by calculating indices of performance such as the area under receiver operator characteristic curves (AUC) and interval likelihood ratios that are relatively insensitive to disease prevalence. Results: Among children with 0–30 WBCs/mm³ in CSF who met study criteria, acute bacterial meningitis was identified in ten of 7,701 (0.1%) for the period from 1993 to 1999 and supplemented with 11 additional cases for the period from 1984 to 1992. AUC values for ancillary tests were 0.61 for total protein concentration, 0.69 for glucose concentration, and 0.90 for percent neutrophils. Interval likelihood ratios were unremarkable for mildly abnormal test results. In contrast, interval likelihood ratios for markedly abnormal test results were higher: 22 for total protein concentration >120 mg/dL, 57 for neutrophils >75%, 15 for glucose concentration <20 mg/dL, and 20 for glucose concentration >120 mg/dL. Conclusions: When markedly abnormal, results of CSF total protein concentration, glucose concentration, and percent neutrophils have value for diagnosing acute bacterial meningitis, even among children with a low WBC count in CSF.     

Cefotaxime and desacetylcefotaxime pharmacokinetics in infants and children with meningitis.

The pharmacokinetics and cerebrospinal fluid (CSF) penetration of cefotaxime (Ctx) and desacetylcefotaxime (dCtx) were evaluated in 13 infants and children with meningitis after dose 6 of Ctx in a multiple-dose intermittent intravenous infusion regimen (50 mg/kg every 6 h). Model-dependent and noncompartmental pharmacokinetic parameters were determined and were found to be congruous. The disposition of both Ctx and dCtx was described adequately by a one-compartment, open model. Noncompartmental pharmacokinetic parameters are reported. The mean Ctx serum concentration at 0.25 h postinfusion was 121.2 micrograms/ml, and the mean CSF concentration at 1 h postinfusion was 6.2 micrograms/ml. The CSF/serum ratio was variable (0 to 20%), with a mean penetration of 10.1%. The mean Ctx elimination half-life, apparent steady-state volume of distribution, and total body clearance were 0.8 h, 0.361 liter/kg, and 0.289 liter/h per kg, respectively. For Ctx, 61% of the dose was excreted unchanged in the urine during the 6-h postinfusion period, and the estimated renal clearance was 0.174 liter/h per kg. No significant correlations were observed between Ctx pharmacokinetic parameters and demographic parameters. The mean peak concentration of dCtx in serum (21.6 micrograms/ml) occurred at approximately 1.5 h postinfusion, and the mean concentration in CSF at 1 h postinfusion was 5.6 micrograms/ml. The CSF/serum ratio was extremely variable (0 to 103%), and the mean penetration was 28.8%. The mean apparent elimination half-life for dCtx was 2.1 h. In infants and children with normal renal function, a 50-mg/kg dose of Ctx administered every 6 h should provide adequate concentrations in serum and CSF in the majority of patients with meningitis.     

降钙素原和基质金属蛋白酶-9在小儿颅内感染中的改变及其价值探讨

目的 观察中枢神经系统感染患儿血清和脑脊液中降钙素原(PCT)、基质金属蛋白酶-9 (MMP-9)水平的变化,探讨其对化脓性脑膜炎、病毒性脑炎的鉴别诊断价值.方法 选取2014年9月至2015年12月青岛市妇女儿童医院神经内科病房收治的脑(膜)炎患儿73例,其中化脓性脑膜炎患儿22例(化脑组),病毒性脑炎患儿51例(病脑组)作为研究对象,并选择非感染性无热惊厥患儿20例作为对照组.所有受试者均于入院后24h内,在无菌条件下行腰椎穿刺采集脑脊液2.0 mL,同时采取静脉血4 mL,采用双抗体夹心法酶联免疫吸附试验(EHSA)检测血清、脑脊液MMP-9水平,电化学发光法检测血清、脑脊液PCT水平.多组间比较采用方差分析,组间两两比较应用SNK-q检验,阳性率显著性比较用四格表X2检验,相关性分析采用直线相关分析法.结果 化脑组患儿血清、脑脊液PCT水平明显高于对照组、病脑组,差异具有统计学意义(均P＜0.01),而病脑组PCT水平与对照组比较差异无统计学意义(P＞0.05);化脑组患儿血清、脑脊液MMP-9水平明显高于对照组、病脑组,病脑组较对照组亦明显升高,差异均具有统计学意义(均P＜0.01);化脑组患儿血清、脑脊液PCT异常升高率明显高于病脑组,差异具有统计学意义(均P＜0.01),而血清、脑脊液MMP-9异常升高率两组间差异无统计学意义(P＞0.05);直线相关分析显示,化脑组PCT和MMP-9血清水平呈正相关(r=0.694,P＜0.01),脑脊液PCT和MMP-9水平也呈正相关(r=0.498,P＜0.01),而病脑组血清、脑脊液PCT含量基本正常,与MMP-9无相关性(均P＞0.05).结论 联合检测血清、脑脊液PCT、MMP-9水平对化脓性脑膜炎、病毒性脑炎的鉴别诊断具有一定的临床价值.