摘要
目的探讨脑脊液乳酸水平在新生儿细菌性脑膜炎诊断中的价值。方法收集2014年1月至2015年3月复旦大学附属儿科医院新生儿科住院患儿脑脊液。采用血气分析仪检测脑脊液乳酸、葡萄糖水平。采用纸片法检测血糖水平及脑脊液葡萄糖水平。根据脑脊液培养、细胞数及临床表现将纳入患儿分为细菌性脑膜炎组（观察组）与非细菌性脑膜炎组（对照组），利用Stata12．0软件对数据进行统计学分析。结果共纳入93例患者，其中观察组16例，对照组77例。观察组脑脊液乳酸、脑脊液乳酸／脑脊液糖比值中位数分别为4．2mmol／L、2．32，高于对照组的1．3mmol／L、0．52，差异有统计学意（Z=-6．19、5．92，P均〈0．05）；观察组脑脊液糖、脑脊液糖／血糖比值中位数分别为1．25mmol／L、0．44，较对照组（2．50mmol／L、0．81）明显低，差异有统计学意义（Z=4．97、4．43，P均〈0．05）。作为诊断细菌性脑膜炎指标时，脑脊液乳酸最佳界值2．2mmol／L，其阳性预测值（PPV）为72．7％、阴性预测值（NPV）为100．0％；脑脊液乳酸／脑脊液糖最佳界值1．24，PPV为94．1％、NPV为100．0％；脑脊液糖最佳界值2．0mmol／L，其PPV为65．0％、NPV为96．9％；脑脊液糖／血糖比值最佳界值0．6，其PPV为60．0％、NPV为96．9％。结论脑脊液乳酸可作为新生儿细菌性脑膜炎诊断指标之一。
Objective To study the significance of the cerebrospinal fluid （CSF）lactate level in diagnosing neonatal bacterial meningitis （BM）. Methods The CSF samples were collected from neonates admitted to Neonatal Ward of Children＇s Hospital of Fudan University between January 2014 and March 2015. CSF lactate and glucose con- centrations were measured with blood - gas analyzer. CSF and serum glucose levels were measured with glucometer. The enrolled neonates were divided into 2 groups based on CSF culture, CSF white blood cells（WBCs） and clinical presenta- tion ： observation group （ neonates with BM） and control group （ neonates without BM）. Statistical analysis of data was performed with Stata 12. O. Results A total of 93 infants （ 16 assigned to observation group and 77 assigned to control group） met the inclusion criteria. Neonates in observation group had higher median CSF lactate level （4.2 mmol/L）and CSF lactate/glucose ratio （L/Gcsf）（2.32 mmol/L） ,than those in control group （1.3 mmol/L,0.52）, and there were significant differences （Z = -6.19, -5.92, all P 〈 0.05 ）. CSF glucose levels were lower in observation group （me- dian, 1.25 mmol/L） than those in control group （ median,2.5 mmol/L）, and the difference was significant （ Z = 4.97, P 〈 0. 05） ; CSF/serum glucose ratio （CSF/Sglu） were lower in observation group （ median, 0.44 vs O. 81 in control group）, and the difference was significant（ Z = 4.43, P 〈 0. 05 ）. The optimal CSF lactate cutoff point of 2.2 mmol/L had a positive predictive value （PPV） of 72.7% and negative predictive value （NPV） of 100.0% for bacterial meningi- tis. The optimal L/Gcsf cutoff point of 1.24 had a PPV of 94.1% and NPV of 100.0%. The optimal CSF glucose cutoff point of 2.0 mmol/L had a PPV of 65.0% and NPV of 95.9%. The optimal CSF/Sglu cutoff point of O. 6 had a PPV of 60.0% and a NPV of 96.9%. Conclusion CSF lactate may be an excellent biomarker for early diagnosis of neo- natal BM.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第6期448-451,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
细菌性脑膜炎
脑脊液乳酸
脑脊液糖/血糖比值
Bacterial meningitis
Cerebrospinal fluid lactate
Cerebrospinal fluid/serum glucose ratio
