脑脊液检查在早产儿及足月儿细菌性脑膜炎的诊断价值

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(P0.05);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。

Diagnostic Value of Cerebrospinal Fluid Examination in Preterm Infants and Full-term Infants Bacterial Meningitis

ABSTRACT 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.