入院首次血炎症指标和脑脊液参数对儿童细菌性脑膜炎的诊断价值

郭启秀; 赵武; 杭航; 马晓倩; 郑子凡; 孙琦

入院首次血炎症指标和脑脊液参数对儿童细菌性脑膜炎的诊断价值

The diagnostic value of the first blood inflammatory indicators and cerebrospinal fluid parameters after admission for bacterial meningitis in children

摘要

摘要:
目的： 探讨入院首次血炎症指标和脑脊液（CSF）参数对儿童细菌性脑膜炎（BM）的诊断价值。
方法： 选取BM患儿105例为研究对象，同期诊断为病毒性脑炎或脑膜炎患儿170例为对照组。收集患儿入院24 h内血炎症指标白细胞计数（WBC）、中性粒细胞计数（NEUT）、中性粒细胞百分比（NEUT%）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、红细胞分布宽度-CV与血小板比值、红细胞分布宽度-SD与血小板比值、血清降钙素原（PCT）、C反应蛋白（CRP）和入院48 h内CSF参数CSF-WBC、CSF乳酸（CSF-LA）、CSF蛋白（CSF-PRO）、CSF葡萄糖（CSF-GLU）、CSF氯化物（CSF-CL）及CSF细菌培养、脑脊液宏基因组二代测序（mNGS）、血培养结果。
结果： 105例BM患儿中，临床诊断68例（64.76%），病原学诊断38例（36.19%），其中CSF培养阳性25例（23.81%）、CSF革兰染色阳性2例、CSF mNGS阳性12例（共送检15例，其中1例CSF mNGS和CSF培养均阳性）。BM组和对照组患儿WBC、NEUT、NEUT%、NLR、PCT、CRP、CSF-WBC、CSF-LA、CSF-GLU、CSF-CL和CSF-PRO差异均有统计学意义（P ＜ 0.05 ~ P ＜ 0.01）。多因素logistic回归分析显示，WBC、CSF-LA和CSF-PRO均为BM独立影响因素（P ＜ 0.05 ~ P ＜ 0.01）。ROC曲线分析显示，WBC、CSF-LA、CSF-PRO诊断儿童BM的AUC分别为0.670、0.982和0.964，三者联合诊断儿童BM的AUC为0.991，优于WBC、CSF-LA和CSF-PRO。
结论： WBC、CSF-LA、CSF-PRO可作为儿童BM的诊断预测因子，WBC + CSF-LA + CSF-PRO联合指标可提高儿童BM的诊断预测效能，CSF mNGS可提高儿童BM病原检出率。

Abstract:
Objective To explore the diagnostic value of the first blood inflammatory indicators and cerebrospinal fluid (CSF) parameters after admission for bacterial meningitis (BM) in children.
Methods A total of 105 children with BM were selected as the research subjects, and 170 children diagnosed with viral encephalitis or meningitis during the same period were selected as the control group. The blood inflammatory indicators white blood cell count (WBC), neutrophil count (NEUT), percentage of neutrophils (NEUT%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width -CV to platelet ratio, red blood cell distribution width -SD to platelet ratio, serum drop Procalcitonin (PCT) and C-reactive protein (CRP) within 24 hours of admission, CSF parameters CSF-WBC, CSF lactic acid (CSF-LA), CSF protein (CSF-Pro), CSF glucose (CSF-Glu) and CSF chloride (CSF-CL), and results of CSF bacterial culture, cerebrospinal fluid metagenomic next-generation sequencing (mNGS) and blood culture in two groups were collected.
Results Among the 105 children with BM, 68 cases (64.76%) were diagnosed clinically, and 38 cases (36.19%) were diagnosed etiologically. Among them, 25 cases (23.81%) were positive for CSF culture, 2 cases were positive for CSF Gram staining, and 12 cases were positive for CSF mNGS (a total of 15 cases were sent for examination, among which 1 case was positive for both CSF mNGS and CSF culture). The differences of WBC, NEUT, NEUT%, NLR, PCT, CRP, CSF-WBC, CSF-LA, CSF-GLU, CSF-CL and CSF-PRO were statistically significant between the BM group and control group (P ＜ 0.05 to P ＜ 0.01). The results of multivariate logistic regression analysis showed that the WBC, CSF-LA and CSF-PRO were the independent influencing factors of BM (P ＜ 0.05 to P ＜ 0.01). The results of ROC curve analysis showed that the AUCs of WBC, CSF-LA, and CSF-PRO in diagnosing childhood BM were 0.670, 0.982, and 0.964, respectively. The AUC of the combined diagnosis of the three for childhood BM was 0.991, which was superior to that of WBC, CSF-LA, and CSF-PRO.
Conclusions The WBC, CSF-LA, and CSF-PRO can be used as the diagnostic predictors of BM in children. The combined index of WBC + CSF-LA + CSF-PRO can improve the diagnostic and predictive efficacy of BM, and the CSF mNGS can increase the pathogen detection rate of BM in children.

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