脑脊液乳酸和β2微球蛋白对细菌性脑膜炎的诊断价值

The value of cerebrospinal fluid lactic acid and beta-2-microglobulin in the diagnosis of bacterial meningitis

目的 探讨脑脊液（CSF）乳酸（LA）和β2微球蛋白（β2-MG）是否有助于细菌性脑膜炎（BM）的诊断,以及与CSF白细胞（WBC）、蛋白相比较,二者是否诊断价值更高.方法 选取BM患者30例作为BM组,外科手术蛛网膜下隙阻滞麻醉患者30例作为对照组.采用强生Vitros950全自动干式化学分析仪检测CSF的LA浓度,采用AIA1800酶免分析仪检测CSF的β2-MG浓度.使用SPSS 13.0软件和受试者工作特征曲线（ROC曲线）进行数据处理.结果 BM组CSF的LA为1.53（0.50） mmol/L,对照组为1.11（0.34） mmol/L,差异有统计学意义（P＜0.05）;BM组CSF的β2-MG为2.61（1.00） mg/L,对照组为0.83（0.45） mg/L,差异有统计学意义（P＜0.01）.对于BM的诊断,CSF的WBC、蛋白、LA和β2-MG的ROC曲线下面积分别为0.760,0.936,0.705,0.960.LA诊断BM的最佳分界值为1.78 mmol/L,敏感度为68.0％,特异度为88.9％;β2-MG诊断BM的最佳分界值为1.756mg/L,敏感度为92.0％,特异度为99.4％.结论 CSF的LA和β2-MG对BM均有诊断价值,但是对于诊断价值的高低,LA低于WBC、蛋白,而β2-MG则高于WBC和蛋白,有较高的诊断敏感度和特异度.

Objective To explore the significance of cerebrospinal fluid lactic acid （LA） and beta2-microglobulin （β2-MG） on the diagnosis of bacterial meningitis,and study their values compared with white blood cell （WBC） or protein in cerebrospinal fluid.Methods Thirty patients with bacterial meningitis were selected as bacterial meningitis group,and 30 surgical patients requiring spinal anesthesia were as control group.The level of cerebrospinal fluid LA was detected by Vitros950 automatic analyzer,and the level of cerebrospinal fluid β2-MG was detected by automatic AIA1800 enzyme immune analyzer.SPSS 13.0 and receiver operating characteristic curve （ROC curve） was used to analyze the data.Results The cerebrospinal fluid LA level in bacterial meningitis group was 1.53 （0.50） mmol/L,in control group was 1.11 （0.34） mmol/L,and there was statistical difference （P 〈 0.05）.The cerebrospinal fluid β 2-MG level in bacterial meningitis group was 2.61 （1.00） mg/L,in control group was 0.83 （0.45） mg/L,and there was statistical difference （P 〈 0.01）.For bacterial meningitis diagnosis,the areas under the ROC curve of cerebrospinal fluid WBC,protein,LA and β2-MG were 0.760,0.936,0.705 and 0.960.The best boundary value of LA in bacterial meningitis diagnosis was 1.78 mmol/L with a sensitivity of 68.0% and specificity of 88.9%.The best boundary value of β2-MG in bacterial meningitis diagnosis was 1.756 mg/L,with a sensitivity of 92.0% and specificity of 99.4%.Conclusions Both cerebrospinal fluid LA and β 2-MG is valuable in the diagnosis of bacterial meningitis.But for the diagnostic value,cerebrospinal fluid LA is not as good as WBC or protein in cerebrospinal fluid,but β2-MG is better than them.It has high sensitivity and specificity.