脑脊液C反应蛋白和腺苷脱氨酶检测在小儿脑膜炎中的诊断价值探讨

Investigation on the diagnosis significance of C reactive protein and adenosine deaminase in cerebrospinal fluid among children with meningitis

目的探讨小儿脑脊液C反应蛋白和腺苷脱氨酶在结核性脑膜炎、化脓性脑膜炎和病毒性脑膜炎早期诊断中的临床意义。方法分别检测315例小儿脑膜炎患儿(包括结核性脑膜炎102例、化脓性脑膜炎108例、病毒性脑膜炎105例)及96例非脑膜炎外科手术患儿(对照组)脑脊液C反应蛋白和腺苷脱氨酶含量,并做比较。结果结核性脑膜炎组及化脓性脑膜炎组脑脊液C反应蛋白、腺苷脱氨酶含量明显高于对照组及病毒性脑膜炎组(P<0.05),而病毒性脑膜炎组与对照组之间差异无统计学意义(P>0.05)。化脓性脑膜炎组脑脊液C反应蛋白含量明显高于结核性脑膜炎组(P<0.05),而腺苷脱氨酶含量则低于结核性脑膜炎组(P<0.05)。化脓性脑膜炎组脑脊液C反应蛋白均为阳性,阳性率为100%;结核性脑膜炎组有63例阳性,阳性率为61.76%;病毒性脑膜炎组均为阴性。结论脑脊液C反应蛋白和腺苷脱氨酶对细菌性脑膜炎(化脓性脑膜炎和结核性脑膜炎)与病毒性脑膜炎的鉴别诊断有重要的参考价值。腺苷脱氨酶可能是诊断结核性脑膜炎的良好指标。

Objective To determine C reactive protein and adenosine deaminase in cerebrospinal fluid,and to investigate the clinical diagnosis significance for tuberculosis meningitis,purulent meningitis and viral meningitis.Methods A total of 315 children with meningitis（ 102 cases of tuberculosis meningitis,108 cases of purulent meningitis and 105 cases of viral meningitis） were enrolled,96 children undergoing operation without meningitis were enrolled as control group,and their cerebrospinal fluid samples were collected. The levels of C reactive protein and adenosine deaminase were determined,and the results were compared. Results C reactive protein and adenosine deaminase in control and viral meningitis groups were significantly lower than those in tuberculosis and purulent meningitis groups（ P 〈 0. 05）. Viral meningitis and control groups had no statistical significance（ P 〉 0. 05）. C reactive protein in purulent meningitis group was higher than that in tuberculosis meningitis group（ P 〈 0. 05）,and adenosine deaminase was lower than that in tuberculosis meningitis group（ P 〈 0. 05）. C reactive protein in purulent meningitis group was positive,and the positive rate was 100%. There were 63 positive cases in tuberculosis meningitis group,and the positive rate was 61. 76%. That in viral meningtis was negative. Conclusions In cerebrospinal fluid,C reactive protein and adenosine deaminase determinations have important reference significance for the differential diagnosis of bacterial meningitis（ purulent meningitis and tuberculosis meningitis） and viral meningitis. Adenosine deaminase may be a good indicator for the diagnosis of tuberculosis meningitis,in order to provide the reference for the early diagnosis of various types of meningitis.