细菌性脑膜炎患儿脑脊液一氧化氮变化的研究

Changes in cerebrospinal fluid nitric oxide concentration in children with bacterial meningitis

目的 观察细菌性脑膜炎患儿脑脊液一氧化氮 (NO)的变化及地塞米松对其的影响。方法 应用Griess法和氨基酸自动分析仪检测 2 3例细菌性脑膜炎患儿脑脊液中NO代谢终产物———亚硝酸盐和NO前体———L 精氨酸的浓度 ,并将 3 1例无神经系统疾病患儿的脑脊液作为对照组。结果 ( 1)治疗前 ,细菌性脑膜炎患儿脑脊液亚硝酸盐浓度 [( 10 76± 4 0 9) μmol/L]明显高于对照组[( 2 69± 1 2 0 ) μmol/L],差异有显著性 (t′=10 41,P <0 0 1) ;经治疗后 ,脑脊液亚硝酸盐浓度渐下降。脑脊液指标恢复正常后 ,亚硝酸盐浓度 [( 3 0 0± 1 16) μmol/L]与对照组差异无显著性 (t =1 2 4 ,P >0 0 5 )。 ( 2 ) 2 3例细菌性脑膜炎患儿中 ,14例单用抗生素治疗 ,其余 9例在抗生素治疗的基础上 ,加用地塞米松治疗。抗生素 +地塞米松治疗组脑脊液亚硝酸盐浓度 [( 5 92± 1 90 ) μmol/L]显著低于单用抗生素组 [( 8 86± 3 5 0 ) μmol/L],差异有显著性 (t=2 3 0 ,P <0 0 5 )。 ( 3 )细菌性脑膜炎患儿治疗前脑脊液L 精氨酸浓度 [( 12± 6) μmol/L]显著低于对照组 [( 17± 8) μmol/L],差异有显著性 (t=2 2 9,P <0 0 5 )。结论 NO参与了细菌性脑膜炎的病理过程 ,而地塞米松能部分抑制NO的过度产生。

Objective To investigate nitric oxide in cerebrospinal fluid (CSF) in children with bacterial meningitis and to evaluate the therapeutic effect of dexamethasone on its changes. Methods The concentrations of the end product of nitric oxide (nitrite) and its precursor (L-arginine) in CSF of 23 cases of bacterial meningitis were detected with Griess method and an amino acid analyzer. Thirty-one children without any neuralogic diseases were included in the control group. Results (1) The CSF nitrite level of children with bacterial meningitis before the treatment of antibiotics [(10.76±4.09) μmol/L] was significantly higher than that of the control group [(2.69±1.20) μmol/L](t′=10.41,P<0.01). The concentration of nitrite in children with bacterial meningitis declined to the normal range [(3.00±1.16) μmol/L] after the treatment of antibiotics with or without dexamethasone administration. (2) Among the 23 patients, 14 were treated with antibiotics only, and the other 9 patients were treated with pulsed dexamethasone therapy. Dexamethasone exerted a significant effect on nitric oxide level (t=2.30,P<0.05). (3) CSF level of L- arginine was lower in patients [(12±6) μmol/L] than that of controls [(17±8) μmol/L](t=2.29,P<0.05). Conclusion Enhanced NO production may play a role in the neuropathology of bacterial meningitis, and dexamethasone might partially inhibit the over production of nitric oxide.