C反应蛋白检测在诊断新生儿细菌性脑膜炎中的应用分析

目的 探讨C反应蛋白水平检测在诊断新生儿细菌性脑膜炎中的临床应用价值.方法 选取我院新生儿科收治的32例急性细菌性脑膜炎新生儿患者为观察组,选取同期于我院住院治疗的30例病毒性脑膜炎的新生儿患者为对照组,对比2组患儿的脑脊液细胞数、脑脊液蛋白以及血清C反应蛋白的检测结果,同时对比2组患儿治疗前后C反应蛋白的变化情况.结果 观察组脑脊液细胞数、脑脊液蛋白以及血清C反应蛋白检测结果均明显高于对照组（P＜0.05）.经过规范治疗后,观察组血清C反应蛋白水平较治疗前明显下降（P＜0.05）,2组患儿治疗后的C反应蛋白水平比较,差异无统计学意义（P＞0.05）.结论 在新生儿细菌性脑膜炎的诊疗过程中,监测其C反应蛋白水平变化,能够对临床抗感染药物的选择、疗程的制定以及疾病预后判断起到重要的参考作用.     

细菌性脑膜炎患儿血清C反应蛋白水平及临床意义

目的 检测急性细菌性脑膜炎患儿外周血C反应蛋白(CRP)水平,并探讨其在疾病发展过程中的价值.方法 采集32例急性细菌性脑膜炎患儿、10例病毒性脑膜炎患儿及12例健康儿童外周血标本,检测血清CRP浓度.对细菌性脑膜炎患者采用了抗生素治疗,待病情控制后再次检测CRP水平,观察CRP对病情的预测价值.结果 急性细菌性脑膜炎患儿血清CRP水平明显高于病毒性脑膜炎患儿和健康儿童 (P＜0.001).细菌性脑膜炎患者接受抗生素治疗后,CRP水平显著下降(P＜0.001),接近健康对照者.结论 急性细菌性脑膜炎患儿血清CRP明显升高,提示脑脊膜急性细菌感染引起急性炎症反应,可以用来判断疾病的发展、预后.     

联合检测脑脊液C反应蛋白及免疫球蛋白水平对感染性脑膜炎患儿的临床意义

目的：评估联合检测脑脊液C反应蛋白（C-reactive protein ,CRP）及免疫球蛋白（Immunoglobulin ,Ig）水平对儿童感染性脑膜炎的诊断价值。方法选择2008-03-2012-06我院收治的感染性脑膜炎患儿59例为观察组,并根据病因分为化脓性脑膜炎（Purulent meningitis ,PM）组20例,结核性脑膜炎（Tuberculous meningitis ,TM）组23例和病毒性脑膜炎（Viral meningitis ,VM ）组16例。选择同期非中枢神经系统感染性疾病患儿20例作为对照组。检测并比较2组患儿CRP和Ig水平（IgA、IgG和IgM）。结果观察组患儿CRP、IgA、IgG和IgM水平明显高于对照组,差异具有统计学意义（P＜0·05）;PM 患儿CRP水平明显高于TM组和VM组,TM组IgA、IgG水平明显高于细菌PM、VM组,差异具有统计学意义（P＜0·05）。结论联合检测CRP和Ig对儿童感染性脑膜炎具有重要的诊断价值,从而指导临床用药。     

C反应蛋白检测对小儿中枢神经系统感染的临床意义

目的：评价C反应蛋白检测对小儿中枢神经系统感染的临床意义。方法选取我院儿科于2010-11-2013-11收治的75例化脓性脑膜炎患儿作为化脑观察组,选取75例病毒性脑炎患儿作为病脑观察组,选取75例正常儿童作为对照组,对比3组患儿的血清与脑脊液C反应蛋白含量。结果化脑观察组血清与脑脊液中C反应蛋白检测结果均明显高于病脑观察组与对照组,差异有统计学意义（P＜0·01）,病脑观察组血清与脑脊液中C反应蛋白检测结果均明显高于对照组,差异有统计学意义（P＜0·01）;治疗后化脑观察组与病脑观察组C反应蛋白检测结果均明显小于治疗前,差异有统计学意义（P＜0·01）。结论 C反应蛋白的检测对于诊断中枢神经系统感染有较高的敏感性,对化脓性脑膜炎与病毒性脑炎有一定的鉴别诊断意义,可以帮助判断病情的进展与恢复情况,操作简便,值得临床推广。     

急性脑血管病患者血清超敏C反应蛋白水平的变化及临床意义

目的分析急性脑血管病患者血清超敏C反应蛋白(hs-CRP)水平变的化及临床意义。方法选取急性脑血管病患者216例与同期健康体检者216例为研究对象,2组均进行血清hs-CRP水平测定并进行对比,分析血清hs-CRP水平对急性脑血管病患者病情进展的影响。结果发病第1天、第7天、第14天急性脑血管病患者血清hs-CRP检测值均高于对照组(P0.05)。血清hs-CRP水平检测值与患者预后的关系:发病第1天,体征改善与体征无改善患者间血清hs-CRP水平检测值无明显差异(P0.05);发病第14天,体征改善患者血清hs-CRP水平检测值明显低于体征无改善者(P0.05)。结论血清hsCRP参与了急性脑血管疾病发生与发展,其水平变化与患者预后关系密切,临床可将血清hs-CRP水平变化作为评定患者病情进展及预后效果的指标。     

急性脑梗死患者高敏C反应蛋白和氧化低密度脂蛋白水平的临床意义

本文选择我院收治的急性脑梗死患者,观察高敏C反应蛋白和氧化低密度脂蛋白水平改变对急性脑梗死发生和发展的意义。     

脑梗死患者血清高敏C反应蛋白水平的变化及其临床意义

目的　探讨脑梗死患者血清高敏C反应蛋白(hsCRP)水平的变化及其与脑梗死严重程度的关系。方法　测定93例脑梗死患者和44名健康人的血清hsCRP含量,并分析其与脑梗死患者临床神经功能缺损程度评分的相关性。结果　脑梗死组血清hsCRP水平明显高于正常对照组(P<0. 01)。脑梗死不同临床分型组间血清hsCRP水平比较,重型组明显高于中型、轻型组,差异均有显著性(均P<0 .05)。脑梗死患者血清hsCRP含量与临床神经功能缺损程度评分呈正相关(r=0 .252,P<0 .05)。结论　血清hsCRP水平增高与脑梗死的发生和严重程度有密切关系,hsCRP可能是脑梗死发病的一个危险因素。     

急性脑梗死患者C反应蛋白水平与病情及预后的关系

目的探讨急性脑梗死患者血清C反应蛋白（CRP）与病情及预后的关系。方法测定65例急性脑梗死患者血清CRP含量,并与30名体检健康者进行对照,同时对急性脑梗死患者血清CPR水平与病情进行相关分析。结果脑梗死组血清CRP水平高于对照组（P〈0.01）;脑梗死不同临床分型间血清CRP水平比较,重型组高于中型、轻型组,差异均有显著性（P〈0.05）;脑梗死预后好转组CRP水平低于无好转组（P〈0.05）。结论急性脑梗死患者血清CRP水平升高提示病情重、预后差;早期测定CRP水平有助于评估急性脑梗死的病情及预后。     

脑梗死患者急性期血清C反应蛋白的动态变化及临床意义

目的 探讨急性脑梗死(ACI)患者血清C反应蛋白(CRP)的含量变化及其临床意义.方法 随机选择80例急性脑梗死患者,采用液相免疫沉淀散射比浊法对患者检测血清CRP水平,按梗死灶大小分组观察,并对其神经功能缺损进行标准评分.结果 急性脑梗死不同梗死灶组比较,大小梗死组卒中后5 ～ 7 d水平最高,随后逐渐下降,两组均较腔梗组为高(P<0.01);不同临床分型组间比较,重型组明显高于中型、轻型组、(均P<0.01).结论 血清CRP水平增高与急性脑梗死发生、梗死灶大小和严重程度关系密切,CRP可考虑作为急性脑梗死患者评估病情的指标之一.     

急性细菌性脑膜炎和病毒性脑膜炎的鉴别诊断

目的　研究多项实验室检测指标在急性细菌性和病毒性脑膜炎鉴别诊断中的敏感性及量化标准 ,并探讨其临床应用价值。方法　对 2 6例急性细菌性和 31例病毒性脑膜炎患者进行回顾性研究 ,分别比较其临床症状、外周血像 ,血糖和脑脊液白细胞数、蛋白、糖的检测结果。结果　从临床症状和外周血像上很难鉴别急性细菌性和病毒性脑膜炎 ,但当脑脊液的糖 <1.7mm ol/ L、脑脊液白细胞总数 >2 0 0 0× 10 6/ L、中性粒细胞数 >10 0 0× 10 6/ L、蛋白 >2 .0 g/ L、脑脊液糖与血糖比值 <0 .35时应高度怀疑细菌性脑膜炎。上述指标鉴别两者的敏感性依序为 :脑脊液糖与血糖比值、脑脊液糖、蛋白和脑脊液中性粒细胞数、脑脊液白细胞总数。结论　上述量化标准有助于提高细菌性与病毒性脑膜炎鉴别诊断的敏感性和准确性 ,降低误诊率     

儿童细菌性脑膜炎与病毒性脑炎氧化应激水平的变化及意义

目的观察儿童细菌性脑膜炎与病毒性脑炎氧化应激水平的变化。方法选取病毒性脑炎患儿20例,细菌性脑膜炎20例,细菌性脑膜炎患儿按临床评分分为重症组及轻症组。选取20例无中枢神经系统感染儿童为对照组。于治疗前及治疗10 d后测定脑脊液丙二醛(MDA)及超氧化物歧化酶(SOD)水平。结果治疗前细菌性脑膜炎患儿脑脊液中SOD水平明显低于对照组与病毒性脑炎患儿,治疗后SOD水平较治疗前增加,但仍低于对照组,且SOD水平与疾病严重程度相关,重症患儿SOD水平较轻症患儿降低。细菌性脑膜炎患儿脑脊液中MDA水平明显高于对照组与病毒性脑炎患儿,治疗后MDA水平较治疗前降低,但仍高于对照组,且MDA水平与疾病严重程度相关,重症患儿MDA水平较轻症患儿增高。病毒性脑炎患儿脑脊液SOD、MDA水平与对照组比较,差异无统计学意义(P>0.05)。结论细菌性脑膜炎患儿存在氧化应激,脑脊液SOD与MDA水平有助于细菌性脑膜炎的早期诊断及病情严重程度的判定。     

Cerebrospinal fluid levels of interleukin-6 and interleukin-12 in children with meningitis

Purpose  Certain cytokines play important roles in the pathophysiology of meningitis. The main purpose of this study was to investigate if the levels of interleukin-6 (IL-6) and interleukin-12 (IL-12) in cerebrospinal fluid (CSF) could be diagnostic predictors of bacterial meningitis in children. Methods  CSF was obtained from 95 patients suspected with meningitis. These cases were classified to the bacterial meningitis (n = 12), aseptic meningitis (n = 41), and nonmeningitis (n = 42) groups. The levels of IL-6 and IL-12 in CSF were measured using the enzyme-linked immmunosorbent assays test. Results  The CSF IL-6 levels in the bacterial meningitis group (45.2 ± 50.0 pg/ml) were significantly higher than those in the aseptic meningitis group (12.9 ± 10.2 pg/ml) and the nonmeningitis group (6.5 ± 7.8 pg/ml; p < 0.05). The CSF IL-12 levels in the bacterial meningitis group (69.8 ± 67.1 pg/ml) were significantly higher than those in the aseptic meningitis group (22.9 ± 10.8 pg/ml) and the nonmeningitis group (15.3 ± 11.2 pg/ml; p < 0.05). With regard to diagnosis, the measurement of CSF IL-6 and IL-12 levels showed sensitivities of 96% and 96%, respectively, and specificities of 51% and 75%, respectively. Conclusion  It is suggested that the CSF IL-6 and IL-12 levels are useful markers for distinguishing bacterial meningitis from aseptic meningitis.     

细菌性脑膜炎、病毒性脑膜脑炎脑脊液sCD14的测定及其临床意义

目的 探讨细菌性脑膜炎、病毒性脑膜脑炎时脑脊液sCDl4的变化及其临床意义。方法 细菌性脑膜炎、病毒性脑膜脑炎患者入院24h内腰穿取脑脊液，用ELISA法测sCDl4的浓度，同时记录Glasgow评分，记录距离取脑脊液3d内的一次脑电图异常程度评分。分析脑脊液sCDl4与Glasgow评分和脑电图异常程度评分的关系。结果 细菌性脑膜炎、病毒性脑膜脑炎患者脑脊液sCDl4显著高于对照组，细菌性脑膜炎患者脑脊液sCDl4显著高于病毒性脑膜脑炎患者；脑脊液sCDl4浓度与脑0电图异常程度评分正相关，与Glasgow评分负相关。结论 细菌性脑膜炎、病毒性脑膜脑炎时脑脊液sCDl4显著升高，并且与脑功能损害程度正相关。     

Cerebrovascular involvement in the acute phase of bacterial meningitis

Cerebral ischaemia is a common complication of bacterial meningitis. Although cerebrovascular involvement in the acute phase of inflammation may be particularly important for the still unacceptably high morbidity and mortality, only, a few studies have investigated cerebrovascular changes in bacterial meningitis. We prospectively investigated changes of intracranial cerebral blood flow velocities (CBFV) in 22 patients (12 men, 10 women, mean age 48 years, 19 years, SD) with bacterial meningitis, by means of transcranial Doppler sonography (TCD). According to previously published criteria the degree of arterial narrowing was assessed and related to the patients’ outcome. Elevated CBFVs in the middle cerebral artery were documented in 18/22 patients with markedly increased systolic peak velocities (CBFV of > 210 cm/s) in 7 patients. Serial examinations performed in 11 patients showed elevated CBFV as early as day 1, reaching peak CBFV between day 3 and day 6 after onset of symptoms in most cases. Furthermore, cerebrovascular involvement was also documented by disturbances of physiological slow spontaneous oscillations of blood flow velocities in 5/10 patients examined with TCD. Low Glasgow Coma Scales (< 7) on admission (29% vs 0%), focal cerebral ischaemic deficits (29% vs 7%) and, seizures (43% vs 7%) were more frequent in patients with CBFV of > 210 cm/s. Finally, a poor clinical outcome was significantly related to severe vascular involvement (P < 0.05). Received: 26 February 1996 Received in revised form: 16 July 1996 Accepted: 5 August 1996     

Level of transforming growth factor beta 1 is elevated in cerebrospinal fluid of children with acute bacterial meningitis

We investigated the levels of transforming growth factor beta 1 (TGF-β1) in cerebrospinal fluid (CSF) in children with meningitis, with a view to prognostic relevance. CSF TGF-β1 levels on admission were measured by a sandwich enzyme immunoassay in children with bacterial meningitis (n = 16), aseptic meningitis (n = 12), and control subjects without evidence of central nervous system (CNS) infection (n = 16). Patients were followed up for a mean duration of 13 months, and neurodevelopmental sequelae was determined for those with bacterial meningitis. On admission, CSF TGF-β1 levels were significantly higher in children with bacterial meningitis (mean, standard error, 32.92, 2.36 pg/ml) as opposed to those with aseptic meningitis (25.26, 1.72 pg/ml) (P = 0.0155), or control subjects (20.53, 1.05 pg/ml) (P < 0.0001). The CSF TGF-β1 levels in children with aseptic meningitis were higher than those in the control group, but without significance (P = 0.02). No apparent correlation existed between CSF TGF-β1 levels and CSF protein or cell counts in patients with bacterial meningitis. No significant difference in CSF TGF-β1 levels was found between patients with or without major sequelae following bacterial meningitis. Received: 19 March 1997 Received in revised form: 24 June 1997 Accepted: 20 August 1997     

Abnormalities of cerebral blood flow in the acute phase of bacterial meningitis in adults

Summary The frequency, course and clinical significance of changes in regional cerebral blood flow (rCBF) during bacterial meningitis were investigated in 14 adult patients. The results of^99mTc-hexamethylpropylene amine oxime (HMPAO) single photon emission computed tomography (SPECT) were compared with the clinical signs and findings using cerebral angiography and conventional CT. HMPAO SPECT was performed 2–15 days (median 4.5 days) after the onset of neurological disease. Decreased HMPAO accumulation was detected in 13 patients. SPECT studies revealed focal hypoperfusion cor responding to the clinical symptoms in 6 patients suffering from hemiparesis or hemiataxia. Conventional cranial CT disclosed brain infarction in only 1 patient. Focal hypoperfusion was also found in 7 of 8 patients without clinical evidence of focal neurological deficits. In 6 patients, HMPAO SPECT findings were abnormal although cerebral angiography was normal. At follow-up examinations 3–45 weeks after the acute disease, abnormalities revealed by HMPAO SPECT had improved or had even disappeared in all patients studied. Our results indicate that reduced rCBF is a frequent finding in bacterial meningitis in the adult. In most patients it probably represents a functional and reversible disorder without structural lesion detectable on CT.     

Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis

Background

Differential diagnosis between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker.

Objective

To evaluate the diagnostic accuracy of CSF lactate as a PNBM marker in patients hospitalized after a neurosurgical procedure.

Methods

Between July 2005 and June 2009, a prospective clinical study, in which all patients with clinical suspicion of PNBM were enrolled, was conducted at our neurosurgical Intensive Care Unit. PNBM diagnosis was categorized as proven, probable or negative before the analysis.

Results

Seventy-nine patients, 51 males with a mean age of 50 years (range 32–68 years) were included. Surgery was elective in 76% patients, mostly for brain tumors (57%); thirty PNBM episodes were identified. CSF parameters were significantly different in glucose concentration (27 mg% vs. 73 mg%, p < 0.001), lactate (8 mmol/L vs. 2.8 mmol/L, p < 0.001), CSF neutrophil pleocytosis (850 mm^–3 vs. 10 mm^–3, p < 0.001), and protein levels (449 mg% vs. 98 mg%) between the PNBM and non-PNBM groups. The ROC curve that best fits PNBM diagnosis is lactate.

Conclusion

Increased CSF lactate is a useful PNBM marker, with better predictive value than CSF hypoglycorrhachia or pleocytosis. Lactate levels ≥4 mmol/L showed 97% sensitivity and 78% specificity, with a 97% negative predictive value.     

联合检测CRP,IL-6,Procalcitonin水平在成人脑膜炎诊断中的应用价值

目的 探讨联合检测C-反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(Procalcitonin)水平在成人脑膜炎诊断中的应用价值。方法 选取病毒性脑膜炎患者30例为病毒组,结核性脑膜炎患者30例为结核组,化脓性脑膜炎患者30例为化脓组; 同时选取体检健康者30例为对照组,检测4组血清中CRP,IL-6,Procalcitonin的表达水平; 用ROC曲线下面积分析CRP,IL-6,Procalcitonin水平对成人脑膜炎的诊断价值。结果 健康人群血清中CRP和IL-6的表达水平均比成人脑膜炎患者低,且在病毒性脑膜炎、结核性脑膜炎和化脓性脑膜炎患者中表达水平有明显差异,血清中Procalcitonin的表达水平在化脓性脑膜炎患者中最高(P<0.05),结核性脑膜炎患者次之(P<0.05),健康人群再次之(P<0.05),病毒性脑膜炎患者中最低(P<0.05)。CRP高表达与成人脑膜炎患者脑脊液中蛋白水平呈正相关(r=0.826,P<0.001); Procalcitonin高表达与成人脑膜炎患者脑脊液中葡萄糖水平呈正相关(r=0.866,P<0.001)。诊断病毒性脑膜炎患者与体检健康者CRP,IL-6,Procalcitonin水平的灵敏度分别为83%、87%、87%,特异度为83%、87%、87%; 诊断结核性脑膜炎患者与体检健康者CRP,IL-6,Procalcitonin水平的灵敏度分别为93%、87%、87%,特异度为67%、73%、87%; 诊断化脓性脑膜炎患者与体检健康者CRP,IL-6,Procalcitonin水平的灵敏度分别为87%、87%、87%,特异度为87%、73%、87%; CRP,IL-6和Procalcitonin水平对成人脑膜炎的联合诊断的灵敏度为88.89%,特异度为83.33%,准确度为87.50%。结论 CRP,IL-6,Procalcitonin水平可作为辅助诊断成人脑膜炎的潜在标志物。     

Dexamethasone decreases cerebrospinal fluid soluble tumor necrosis factor receptor 1 levels in bacterial meningitis

It is known that the use of adjunctive dexamethasone in bacterial meningitis reduces audiologic and neurologic sequelae. The cerebrospinal fluid (CSF) level of soluble tumor necrosis factor 1 (sTNFR1) is an important indicator of neurologic sequelae in bacterial meningitis. We measured the CSF levels of IL-6 and sTNFR1 before administration of antibiotics (CSF1) and 1-3 days after administration of antibiotics (CSF2) in nine patients with bacterial meningitis who received dexamethasone sodium and five without dexamethasone. The CSF2 IL-6 levels of patients with/without dexamethasone were significantly lower than for CSF1 IL-6 levels (p = 0.0077, and p = 0.0431, respectively). There were no significant differences of the ratio of CSF2/CSF1 IL-6 levels between patients with dexamethasone and those without dexamethasone. CSF2 sTNFR1 levels of patients with dexamethasone were significantly lower than for CSF1 sTNFR1 levels (p = 0.0208). However, CSF2 sTNFR1 levels of patients without dexamethasone were significantly higher than for CSF1 sTNFR1 levels (p = 0.0422). The ratio of CSF2/CSF1 sTNFR1 levels of patients with dexamethasone was significantly lower than that without dexamethasone (p = 0.0063). Our present study suggests that dexamethasone inhibits increase of CSF sTNFR1 levels after antibiotics therapy in bacterial meningitis.     

急性脑梗死患者同型半胱氨酸、C反应蛋白及血糖水平相关性研究

目的 探讨急性脑梗死患者同型半胱氨酸、C反应蛋白及血糖水平相关性研究.方法 选择我院2008-12～2009-12以来住院诊治的急性脑梗死患者100例,根据病情分为3组,分别测定同型半胱氨酸、C反应蛋白及血糖水平.结果 轻型、中型和重型患者在同型半胱氨酸、C反应蛋白及血糖水平三个指标上均存在不同程度的差异,而且随着患者病情的加重,同型半胱氨酸、C反应蛋白及血糖水平三者均出现增高趋势,且轻型、中型和重型三种情况下的同型半胱氨酸、C反应蛋白及血糖水平均出现显著差异.结论 同型半胱氨酸、C反应蛋白及血糖水平三个指标对于急性脑梗死的检测具有重要的临床诊断价值.