脑脊液检查在早产儿及足月儿细菌性脑膜炎的诊断价值
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摘要
目的:评价脑脊液检查在早产儿及足月儿细菌性脑膜炎诊断中的价值。方法:选取2014年6月1日至2016年12月31日上海市儿童医院新生儿科收治的行腰椎穿刺检查的447例新生儿,回顾性分析新生儿的一般资料、脑脊液常规生化、培养等指标,根据胎龄将患儿分为早产儿167例与足月儿280例,再根据有无患发细菌性脑膜炎分为早产儿细菌性脑膜炎27例(早产儿观察组)、早产儿非细菌性脑膜炎140例(早产儿对照组)、足月儿细菌性脑膜炎38例(足月儿观察组)、足月儿非细菌性脑膜炎242例(足月儿对照组),采用受试者工作特征(ROC)曲线评估蛋白定量、白细胞计数、葡萄糖对早产儿及足月儿细菌性脑膜炎的诊断价值。结果:与同组对照组相比,足月儿观察组和早产儿观察组蛋白定量和白细胞计数均明显升高,而葡萄糖含量显著下降,且差异均具有统计学意义(P<0.05);本研究65例细菌性脑膜炎患儿脑脊液培养分离出11株细菌(16.9%)。足月儿脑脊液白细胞计数、蛋白定量以及葡萄糖诊断细菌性脑膜炎的ROC曲线下面积分别为0.995、0.846、0.703。早产儿脑脊液白细胞计数、蛋白定量以及葡萄糖诊断细菌性脑膜炎ROC曲线下面积分别为0.970、0.711、0.705。结论:脑脊液白细胞计数、蛋白定量在足月儿和早产儿细菌性脑膜炎中具有较高的诊断价值。
Objective: To evaluate the diagnostic value of cerebrospinal fluid examination in preterm infants and full-term infants bacterial meningitis. Methods: 447 neonates who underwent lumbar puncture in Shanghai Children's Hospital from June 1,2014 to December 31, 2016 were selected. The general data, routine biochemistry and culture of cerebrospinal fluid were analyzed retrospectively. According to gestational age, the children were divided into preterm infants of 167 cases and full-term infants of 280 cases. They were divided into preterm infants bacterial meningitis(preterm infants observation group) of 27 cases, preterm infants non bacterial meningitis(preterm infants control group) of 140 cases, full-term infants bacterial meningitis(full-term infants observation group)of 38 cases, full-term infants non bacterial meningitis(full-term infants control group) of 242 cases according to the incidence of bacterial meningitis. Receiver operating characteristic(ROC) curves were used to evaluate the diagnostic value of protein quantification, white blood cell count and glucose for bacterial meningitis in preterm infants and full-term infants. Results: Compared with the control group in the same group,the protein quantitative and white blood cell count in the preterm infants observation group and the full-term infants observation group were significantly increased, and the glucose content were significantly decreased, and the differences were statistically significant(P <0.05). In this study, 11 cases of bacteria(16.9%) were isolated from cerebrospinal fluid cultures of 65 children with bacterial meningitis. The area under the ROC curve of full-term infants cerebrospinal fluid white blood cell count, protein quantification and glucose in the diagnosis of bacterial meningitis were 0.995, 0.846, 0.703 respectively. The area under the ROC curve of preterm infants cerebrospinal fluid white blood cell count, protein quantification and glucose in the diagnosis of bacterial meningitis were 0.970,0.711, 0.705 respectively. Conclusion: Cerebrospinal fluid white blood cell count and protein quantification have high diagnostic value in preterm infants and full-term infants bacterial meningitis.
Objective: To evaluate the diagnostic value of cerebrospinal fluid examination in preterm infants and full-term infants bacterial meningitis. Methods: 447 neonates who underwent lumbar puncture in Shanghai Children's Hospital from June 1,2014 to December 31, 2016 were selected. The general data, routine biochemistry and culture of cerebrospinal fluid were analyzed retrospectively. According to gestational age, the children were divided into preterm infants of 167 cases and full-term infants of 280 cases. They were divided into preterm infants bacterial meningitis(preterm infants observation group) of 27 cases, preterm infants non bacterial meningitis(preterm infants control group) of 140 cases, full-term infants bacterial meningitis(full-term infants observation group)of 38 cases, full-term infants non bacterial meningitis(full-term infants control group) of 242 cases according to the incidence of bacterial meningitis. Receiver operating characteristic(ROC) curves were used to evaluate the diagnostic value of protein quantification, white blood cell count and glucose for bacterial meningitis in preterm infants and full-term infants. Results: Compared with the control group in the same group,the protein quantitative and white blood cell count in the preterm infants observation group and the full-term infants observation group were significantly increased, and the glucose content were significantly decreased, and the differences were statistically significant(P <0.05). In this study, 11 cases of bacteria(16.9%) were isolated from cerebrospinal fluid cultures of 65 children with bacterial meningitis. The area under the ROC curve of full-term infants cerebrospinal fluid white blood cell count, protein quantification and glucose in the diagnosis of bacterial meningitis were 0.995, 0.846, 0.703 respectively. The area under the ROC curve of preterm infants cerebrospinal fluid white blood cell count, protein quantification and glucose in the diagnosis of bacterial meningitis were 0.970,0.711, 0.705 respectively. Conclusion: Cerebrospinal fluid white blood cell count and protein quantification have high diagnostic value in preterm infants and full-term infants bacterial meningitis.
引文
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[14]Yoshimori M,Imadome KI,Tomii S,et al.Cerebrospinal fluid findings in chronic active Epstein-Barr virus infection with central nervous system involvement[J].Rinsho Ketsueki,2018,59(4):367-372
[15]Zhang D.Values of magnetic Resonance imaging and Cerebrospinal fluid analysis in the diagnosis of Central Nervous System associated infectious diseases[J].Pak J Med Sci,2017,33(5):1065-1069
[16]邹海,彭道荣,吴永昌,等.中枢神经系统疾病脑脊液中免疫球蛋白与IL-6的表达与意义[J].现代生物医学进展,2015,15(30)5897-5900Zou Hai,Peng Dao-rong,Wu Yong-chang,et al.Expressions and Significances of IL-6 and Immunoglobulin in the Cerebrospinal Fluid of Patients with Central Nervous System Diseases[J].Progress in Modern Biomedicine,2015,15(30):5897-5900
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[18]赵翠,程国强.新生儿脑脊液检查研究现状及结果解读[J].中国循证儿科杂志,2016,11(4):303-308Zhao Cui,Cheng Guo-qiang.Research status and results interpretation of cerebrospinal fluid examination in neonates[J]Chinese Journal of Evidence-Based Pediatrics,2016,11(4):303-308
[19]Khalid M,Saleem AF.Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood culture among children with acute bacterial meningitis[J].J Pak Med Assoc,2017,67(11):1783
[20]Noureldein M,Mardare R,Pickard J,et al.Cerebrospinal fluid protein and glucose levels in neonates with a systemic inflammatory response without meningitis[J].Fluids Barriers CNS,2018,15(1):8
[21]范惠先,任朝杰,王润青,等.脑脊液检查在中枢神经系统感染性疾病鉴别中的应用[J].医学综述,2015,21(7):1294-1295Fan Hui-xian,Ren Chao-jie,Wang Run-qing,et al.Study on the Application of Cerebrospinal Fluid Examination in the Identification of Infectious Disea-ses of Central Nervous System[J].Medica Recapitulate,2015,21(7):1294-1295
[22]Khalili H,YadollahiKhales G,Isaee M.Diagnostic Accuracy of Peripheral White Blood Cell Count,Fever and Acute Leukocutosis for Bacterial Meningitis in Patients with Severe Traumatic Brain Injury[J].Bull Emerg Trauma,2015,3(2):53-58
[23]Martín-Ancel A,García-Alix A,Salas S,et al.Cerebrospinal fluid leucocyte counts in healthy neonates[J].Arch Dis Child Fetal Neonatal Ed,2006,91(5):F357-F358
[24]Kestenbaum LA,Ebberson J,Zorc JJ,et al.Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants[J].Pediatrics,2010,125(2):257-264
[25]Garges HP,Moody MA,Cotten CM,et al.Neonatal meningitis:what is the correlation among cerebrospinal fluid cultures,blood cultures,and cerebrospinal fluid parameters?[J].Pediatrics,2006,117(4):1094-1100
[26]Lin MC,Chi H,Chiu NC,et al.Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan[J].J Microbiol Immunol Infect,2012,45(6):442-447
[27]Savonius O,Helve O,Roine I,et al.Swiftly Decreasing Cerebrospinal Fluid Cathelicidin Concentration Predicts Improved Outcome in Childhood Bacterial Meningitis[J].J Clin Microbiol,2016,54(6):1648-1649
[28]Lyons TW,Cruz AT,Freedman SB,et al.Correction of Cerebrospinal Fluid Protein in Infants With Traumatic Lumbar Punctures[J].Pediatr Infect Dis J,2017,36(10):1006-1008
[29]Srinivasan L,Shah SS,Padula MA,et al.Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit[J].J Pediatr,2012,161(4):729-734
[30]Jebamalar AA,Prabhat,Balakrishnapillai AK,et al.Cerebrospinal fluid ferritin and albumin index:potential candidates for scoring system to differentiate between bacterial and viral meningitis in children[J].Biomarkers,2016,21(5):424-428
[2]Srinivasan L,Kilpatrick L,Shah SS,et al.Elevations of novel cytokines in bacterial meningitis in infants[J].PLoS One,2018,13(2):e0181449
[3]Ku LC,Boggess KA,Cohen-Wolkowiez M,et al.Bacterial meningitis in infants[J].Clin Perinatol,2015,42(1):29-45
[4]Singh P,Saxena S,Seth A.Bacteriologic Methods in the diagnosis of Acute Bacterial Meningitis[J].Indian Pediatr,2016,53(8):721-722
[5]Ogunlesi TA,Odigwe CC,Oladapo OT.Adjuvant corticosteroids for reducing death in neonatal bacterial meningitis[J].Cochrane Database Syst Rev,2015,11(11):CD010435
[6]Srinivasan L,Kilpatrick L,Shah SS,et al.Cerebrospinal fluid cytokines in the diagnosis of bacterial meningitis in infants[J].Pediatr Res,2016,80(4):566-572
[7]Mentis AF,Kyprianou MA,Xirogianni A,et al.Neutrophil-tolymphocyte ratio in the differential diagnosis of acute bacterial meningitis[J].Eur J Clin Microbiol Infect Dis,2016,35(3):397-403
[8]Jiang H,Su M,Kui L,et al.Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province,China,2012-2015[J].PLo SOne,2017,12(6):e0180161
[9]赵翠,张澜,刘宁,等.脑脊液乳酸水平对新生儿细菌性脑膜炎的诊断价值[J].中华实用儿科临床杂志,2016,31(6):448-451Zhao Cui,Zhang Lan,Liu Ning,et al.Significance of cerebrospinal fluid lactate level in diagnosing neonatal bacterial meningitis[J].Chinese Journal of Applied Clinical Pediatrics,2016,31(6):448-451
[10]Tan NW,Lee EY,Khoo GM,et al.Cerebrospinal fluid white cell count:discriminatory or otherwise for enteroviral meningitis in infants and young children?[J].J Neurovirol,2016,22(2):213-217
[11]Manning L,Laman M,Mare T,et al.Accuracy of cerebrospinal leucocyte count,protein and culture for the diagnosis of acute bacterial meningitis:a comparative study using Bayesian latent class analysis[J].Trop Med Int Health,2014,19(12):1520-1524
[12]Tan J,Kan J,Qiu G,et al.Clinical Prognosis in Neonatal Bacterial Meningitis:The Role of Cerebrospinal Fluid Protein[J].PLo S One,2015,10(10):e0141620
[13]朱凤莲,朱风华,李树军,等.细菌性脑膜炎患儿脑脊液中兴奋性氨基酸的变化及临床意义[J].中国全科医学,2005,8(4):310-311Zhu Feng-lian,Zhu Feng-hua,Li Shu-jun,et al.Change and Significance of Excitatory Amino Acid in Cerebrospinal Fluid in Children with Bacterial Meningitis[J].Chinese General Practice,2005,8(4):310-311
[14]Yoshimori M,Imadome KI,Tomii S,et al.Cerebrospinal fluid findings in chronic active Epstein-Barr virus infection with central nervous system involvement[J].Rinsho Ketsueki,2018,59(4):367-372
[15]Zhang D.Values of magnetic Resonance imaging and Cerebrospinal fluid analysis in the diagnosis of Central Nervous System associated infectious diseases[J].Pak J Med Sci,2017,33(5):1065-1069
[16]邹海,彭道荣,吴永昌,等.中枢神经系统疾病脑脊液中免疫球蛋白与IL-6的表达与意义[J].现代生物医学进展,2015,15(30)5897-5900Zou Hai,Peng Dao-rong,Wu Yong-chang,et al.Expressions and Significances of IL-6 and Immunoglobulin in the Cerebrospinal Fluid of Patients with Central Nervous System Diseases[J].Progress in Modern Biomedicine,2015,15(30):5897-5900
[17]Lyons TW,Cruz AT,Freedman SB,et al.Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture[J].Ann Emerg Med,2017,69(5):622-631
[18]赵翠,程国强.新生儿脑脊液检查研究现状及结果解读[J].中国循证儿科杂志,2016,11(4):303-308Zhao Cui,Cheng Guo-qiang.Research status and results interpretation of cerebrospinal fluid examination in neonates[J]Chinese Journal of Evidence-Based Pediatrics,2016,11(4):303-308
[19]Khalid M,Saleem AF.Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood culture among children with acute bacterial meningitis[J].J Pak Med Assoc,2017,67(11):1783
[20]Noureldein M,Mardare R,Pickard J,et al.Cerebrospinal fluid protein and glucose levels in neonates with a systemic inflammatory response without meningitis[J].Fluids Barriers CNS,2018,15(1):8
[21]范惠先,任朝杰,王润青,等.脑脊液检查在中枢神经系统感染性疾病鉴别中的应用[J].医学综述,2015,21(7):1294-1295Fan Hui-xian,Ren Chao-jie,Wang Run-qing,et al.Study on the Application of Cerebrospinal Fluid Examination in the Identification of Infectious Disea-ses of Central Nervous System[J].Medica Recapitulate,2015,21(7):1294-1295
[22]Khalili H,YadollahiKhales G,Isaee M.Diagnostic Accuracy of Peripheral White Blood Cell Count,Fever and Acute Leukocutosis for Bacterial Meningitis in Patients with Severe Traumatic Brain Injury[J].Bull Emerg Trauma,2015,3(2):53-58
[23]Martín-Ancel A,García-Alix A,Salas S,et al.Cerebrospinal fluid leucocyte counts in healthy neonates[J].Arch Dis Child Fetal Neonatal Ed,2006,91(5):F357-F358
[24]Kestenbaum LA,Ebberson J,Zorc JJ,et al.Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants[J].Pediatrics,2010,125(2):257-264
[25]Garges HP,Moody MA,Cotten CM,et al.Neonatal meningitis:what is the correlation among cerebrospinal fluid cultures,blood cultures,and cerebrospinal fluid parameters?[J].Pediatrics,2006,117(4):1094-1100
[26]Lin MC,Chi H,Chiu NC,et al.Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan[J].J Microbiol Immunol Infect,2012,45(6):442-447
[27]Savonius O,Helve O,Roine I,et al.Swiftly Decreasing Cerebrospinal Fluid Cathelicidin Concentration Predicts Improved Outcome in Childhood Bacterial Meningitis[J].J Clin Microbiol,2016,54(6):1648-1649
[28]Lyons TW,Cruz AT,Freedman SB,et al.Correction of Cerebrospinal Fluid Protein in Infants With Traumatic Lumbar Punctures[J].Pediatr Infect Dis J,2017,36(10):1006-1008
[29]Srinivasan L,Shah SS,Padula MA,et al.Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit[J].J Pediatr,2012,161(4):729-734
[30]Jebamalar AA,Prabhat,Balakrishnapillai AK,et al.Cerebrospinal fluid ferritin and albumin index:potential candidates for scoring system to differentiate between bacterial and viral meningitis in children[J].Biomarkers,2016,21(5):424-428