脑脊液乳酸与血清降钙素原在儿童颅内感染定性中的应用

发布时间：2018-06-12 06:14

本文选题：脑脊液 + 乳酸　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：探讨小儿化脓性脑膜炎和病毒性脑炎中脑脊液乳酸(CSF-LA)及血清降钙素原(PCT)的改变及其临床应用价值。方法：收集2011年11月至2012年2月在重庆医科大学附属儿童医院神经内科住院,且入院时均考虑颅内感染的40例患儿的临床资料。患儿入院后立即采血行相关检查,其中40例行血常规,38例行血清乳酸测定,34例行血清CRP检查,17例行血培养,28例使用免疫色谱检测法测定血清降钙素原水平。40例患儿均于住院后24～72小时内行脑脊液常规与生化检查、细菌培养及脑脊液葡萄糖/血糖比值测定,其中28例行脑脊液涂片检查,所有患儿均采用比色法测定脑脊液乳酸含量,其中2例化脑患儿经正规抗感染治疗后复查CSF-LA。根据临床症状、体征及辅助检查等诊断化脑14例及病脑26例,并对各组CSF-LA, PCT及常规检查等指标进行统计学比较及分析。结果： (1)两组血常规及血清CRP比较：白细胞总数以10×109/L为阳性阈值,化脑组高于此值有61.5%,病脑组有46.2%,两组相比差异无统计学意义(P0.05)；血清CRP以8mg/L为阳性阈值,化脑组高于此值有58.3%,病脑组有31.8%,两组相比差异无统计学意义(P0.05)。 (2)两组脑脊液常规指标比较：化脑组白细胞总数与病脑组相比具有显著性差异(P0.01),但两组结果部分重叠；多核白细胞比率两组相比差异具有统计学意义(P0.05)；但对脑脊液改变不典型的9例化脑患儿,白细胞总数与病脑组相比无差异(P0.05),多核白细胞比率有差异(P0.05)。化脑组蛋白质、葡萄糖定量与病脑组有显著性差异(P0.01)；其中脑脊液改变不典型的化脑患儿与病脑组相比蛋白质、葡萄糖定量有显著差异(P0.01),但部分结果与病脑重叠。化脑组与病脑组氯化物差异无意义(P0.05)；以40%为CSF葡萄糖/血糖比值的阳性阈值,化脑组低于此值有35.7%,病脑组均高于该值,两组相比有显著差异(P0.01),但对脑脊液改变不典型的化脑患儿,其值与病脑组相比差异无统计学意义(P0.05)。 (3)病原学检查：化脑组及病脑组脑脊液涂片均为阴性。化脑组脑脊液培养1例阳性,血培养2例阳性。病脑组脑脊液及血培养均为阴性。 (4)两组CSF-LA的比较：化脑组CSF-LA平均为(2.68±1.50)mmol/L,病脑组为(1.25±0.24)mmol/L,化脑组明显高于病脑组,两组差异具有显著统计学意义(P0.01)。以CSF-LA1.6mmol/L为界点时,其灵敏度、特异度分别为71.4%、96.2%,诊断的综合能力最好,并且其中脑脊液改变不典型的化脑患儿与病脑组相比有显著性差异(P0.01)。CSF-LA与脑脊液白细胞总数呈正相关,与脑脊液葡萄糖水平呈负相关,而与血清乳酸水平无明显相关性。 (5)两组血清PCT的测定及比较：以血清PCT0.5ng/mL为阳性阈值,化脑组高于此值的有45.0%,病脑组有5.9%,化脑组与病脑组相比有差异(P0.05)。结论： (1)外周血象及血清CRP鉴别诊断化脑及病脑的特异性低,单靠2项指标不能区别化脑与病脑。 (2)脑脊液常规检查有助于鉴别化脑与病脑,但对脑脊液改变不典型的化脑,因部分指标结果与病脑重叠,故脑脊液常规检查不能完全区别化脑与病脑。 (3)本组病例病原学检查阳性率低。 (4)化脑组CSF-LA明显高于病脑组。本组病例以CSF-LA1.6mmol/L为界点时,其诊断的综合能力最好,即使对脑脊液改变不典型的化脑患儿,也有较高的诊断价值,故CSF-LA可作为区别化脑与病脑的重要指标,对临床诊疗有重要的应用意义。 (5)化脑组血清PCT水平高于病脑组,极少的病脑患儿PCT增高,故PCT可作为化脑的辅助诊断指标。 (6)鉴于目前大多数化脑患儿在脑脊液检查前均不正规使用抗菌素,故诊断上应结合临床表现、脑脊液检查和血液相关炎性指标改变进行综合判断。
[Abstract]:Objective : To investigate the changes of cerebrospinal fluid lactic acid ( CSF - LA ) and serum calcitonin ( PCT ) in children with suppurative meningitis and viral encephalitis and their clinical application value .

Methods : The clinical data of 40 children with intracranial infection were collected from November 2011 to February 2012 at the Affiliated Children ' s Hospital of Chongqing Medical University .

Results :

( 1 ) Compared with the two groups of blood routine and serum CRP , the total number of white blood cells was 10 脳 109 / L as the positive threshold , the cerebral group was higher than that in 61.5 % and 46.2 % in the cerebral group , there was no significant difference between the two groups ( P0.05 ) .
The serum CRP level was 8 mg / L as the positive threshold and 58.3 % in the cerebral group and 31.8 % in the cerebral group . There was no significant difference between the two groups ( P0.05 ) .

( 2 ) There was significant difference between the two groups ( P0.01 ) , but the two groups were partially overlapped .
There was significant difference between the two groups ( P0.05 ) .
But there was no difference ( P0.05 ) between the total white blood cell count and the disease brain group ( P0.05 ) . There was a significant difference between the protein and glucose in the brain group ( P0.01 ) .
There was a significant difference in the amount of protein and glucose ( P0.01 ) compared with the diseased brain group ( P0.01 ) . However , there was no significant difference between the cerebral group and the encephalopathy group ( P0.05 ) .
There was a significant difference between the two groups ( P 0.01 ) . However , there was no significant difference between the two groups ( P0.05 ) .

( 3 ) The results showed that both cerebral spinal fluid and cerebral spinal fluid were negative in the cerebral spinal fluid .

( 4 ) In comparison with CSF - LA , CSF - LA was ( 2.68 卤 1.50 ) mmol / L , and the cerebral group was ( 1.25 卤 0.24 ) mmol / L . The sensitivity and specificity of CSF - LA were 71.4 % and 96.2 % respectively .

( 5 ) The serum PCT of the two groups was measured and compared : the serum PCT0.5 ng / mL was the positive threshold , the cerebral group was higher than that in 45.0 % , the diseased brain group was 5.9 % , and the cerebral group had a difference compared with the diseased brain group ( P0.05 ) .

Conclusion :

( 1 ) The specificity of peripheral blood image and serum CRP in the diagnosis of brain and encephalopathy is low , and only 2 indexes can not distinguish between the brain and the disease brain .

( 2 ) Routine examination of cerebrospinal fluid helps to differentiate the brain from the diseased brain , but to change the cerebrospinal fluid is not typical of the brain , because the partial index result is overlapped with the disease brain , so the routine examination of the cerebrospinal fluid cannot completely differentiate the brain and the disease brain .

( 3 ) The positive rate of etiological examination in this group was low .

( 4 ) CSF - LA was significantly higher in CSF - LA than in the diseased brain group . CSF - LA could be used as an important index to differentiate the brain from the disease , and the CSF - LA could play an important role in clinical diagnosis and treatment .

( 5 ) PCT level in the brain group was higher than that in the diseased brain group , and the PCT was higher in the children with minimal disease , so the PCT could be used as the auxiliary diagnostic index of the brain .

( 6 ) In view of the abnormal use of antibiotics before cerebrospinal fluid examination , the diagnosis should be combined with clinical manifestation , cerebrospinal fluid examination and blood - related inflammatory indexes .
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

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