血清LDH、 CK、 AST及CSF LDH水平检测在成人颅内感染患者中的临床意义  

Clinical significance of serum myocardial enzymes and CSF LDH detection in adults with intracranial infection

作　　者：吴琼[1] 王堃[1] 陈贞[1] 龙璐[1] 陶亚[1] 邱世飏 易斌[1] 

机构地区：[1]中南大学湘雅医院检验科,长沙410008

出　　处：《中国医师杂志》2015年第4期554-557,共4页Journal of Chinese Physician

摘　　要：目的 探讨血清乳酸脱氢酶（LDH）、肌酸激酶（CK）、天冬氨酸转氨酶（AST）及脑脊液乳酸脱氢酶（CSF LDH）检测在成人颅内感染患者急性期的变化及其临床意义.方法 收集病毒性脑炎（病脑组）47例,结核性脑膜炎（结脑组）30例和化脓性脑膜炎（化脑组）19例及体检正常者（对照组）39例的血清标本,并收集颅内感染组的腰穿脑脊液.采用贝克曼全自动生化分析仪,以酶速率法测定所有标本的血清AST、LDH、CK以及患者CSF的LDH.结果 （1）颅内感染组血清心肌酶LDH、CK、AST水平均显著高于非感染组（P＜0.01）.（2）根据有无瘫痪、抽搐、失语、昏迷等症状将脑膜炎患者分为障碍组和无障碍组,障碍组血清LDH、AST水平均明显高于无障碍组（P＜0.05）.（3）病脑组血清AST、LDH、CK水平,化脑组血清AST、LDH水平及结脑组血清LDH水平均明显高于对照组（P＜0.01）,结脑组和化脑组CSF LDH活性升高程度较病脑组高（P＜0.01）.（4）直线相关分析颅内感染患者血清LDH与脑脊液LDH无相关（P＞0.05）.结论 （1）成人颅内感染急性期存在明显的血清LDH、CK、AST及CSF LDH的改变,以LDH改变最为明显,在合并有脑功能障碍时LDH、AST改变更明显;（2）检测血清LDH、CK、AST和CSF LDH水平有助于颅内感染早期的鉴别诊断,以及判断病情的严重程度.Objective To investigate the changes and clinical significance of serum lactate dehydrogenase （LDH）,creatine kinase （CK）,glutamate pyruvate transaminase （AST）,and cerebrospinal fluid lactate dehydrogenase （CSF LDH） in adult patients with acute central nervous system infection.Methods The levels of myocardial enzymes （AST,LDH,and CK） in serum of 96 adult patients with acute intracranial infection in 7days and 39 healthy people were measured by Beckman automatic biochemical analyzer and enzyme rate assay,and CSF LDH level in 96 patients were measured simultaneously.Results （1） The serum myocardial enzymes （LDH,CK,and AST） of intracranial infection group （47 cases with viral encephalitis,30 cases with tuberculous meningitis,and 19 cases with purulent encephalitis） were significantly higher than those of normal control group （P 〈0.01）.（2）The myocardial enzymes （LDH,and AST ） of patients with cerebral functional disorder were significantly higher than those of patients with normal cerebral function （P 〈0.05）.（3）The levels of serum AST,LDH,and CK in the virus encephalitis group,serum AST and LDH in the purulent encephalitis group,and serum LDH in the tuberculous meningitis group were significantly higher than those in the control group （P 〈 0.01）.The CSF LDH level in the viral meningitis group was prominently lower than that in the tuberculous encephalitis group and purulent encephalitis group,respectively （P 〈0.01）.（4） No correlations were found between CSF LDH and serum myocardial enzymes （P 〉0.05）.Conclusions （1）There is significant change in the levels of serum LDH,CK,AST,and CSF LDH of adult patients with acute intracranial infection,especially in infected patients with cerebral functional disorder,and the change of LDH is the most obvious.（2）The levels of serum myocardial enzymes and CSF LDH are helpful to the differential diagnosis of intracranial infection in early stage,and judging the severity of the illness.

关 键 词：结核 脑膜/代谢 脑膜炎 病毒性/代谢 脑膜炎 细菌性/代谢 乳酸脱氢酶类/代谢 肌酸激酶/血液 天冬氨酸氨基转移酶类/代谢 

分 类 号：R742.9[医药卫生—神经病学与精神病学]