脑膜炎患儿脑脊液LA和NLR表达及其诊断价值  

Expression of LA and NLR in cerebrospinal fluid of children with meningitis and their diagnostic value

作　　者：孙雁[1] 冯丽梅[1] 邵明秀[2] SUN Yan;FENG Li-mei;SHAO Ming-xiu(Maternal and Child Health Hospital of Zibo,Zibo,Shandong 255000,China)

机构地区：[1]淄博市妇幼保健院儿科,山东淄博255000 [2]淄博市妇幼保健院检验科,山东淄博255000

出　　处：《中华医院感染学杂志》2020年第2期246-249,共4页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展计划基金资助项目(2017WS379)。

摘　　要：目的分析脑脊液乳酸(Lactate,LA)、中性粒细胞淋巴细胞比值(Neutrophil-to-lymphocyte ratio,NLR)联合检测对细菌性脑膜炎(BM)与病毒性脑膜炎(VM)患儿的鉴别诊断价值。方法抽取淄博市妇幼保健院2015年1月-2017年12月符合入组标准的BM、VM患儿各50例。记录两组患儿临床症状、特征,测定脑脊液LA含量及中性粒细胞(N)、淋巴细胞(L)比率。全血细胞自动分析仪测定患儿外周血中白细胞计数(WBC)、N、L绝对计数,计算NLR。受试者工作特征曲线(ROC)分析外周血NLR、脑脊液LA、脑脊液NLR诊断BM的敏感度、特异度。结果 BM组头痛患儿占比为14.00%低于VM组、意识障碍及影像学改变患儿分别占14.00%和72.00%均高于VM组(P<0.05);BM组脑脊液LA(4.25±1.91)mmol/L、NLR(6.16±2.43)均高于VM组,外周血WBC(15.53±2.85)×10^9/L、中性粒细胞计数(11.15±2.23)×10^9/L、NLR(4.10±0.61)较VM组明显升高(P<0.05);脑脊液LA>2.01 mmol/L时,诊断BM的敏感度、特异度分别为90.00%、66.00%;脑脊液NLR>3.94时,诊断BM的敏感度、特异度分别为80.00%、92.00%;脑脊液LA联合NLR诊断BM曲线下面积为0.970,敏感度、特异度分别为88.00%、98.00%。结论脑脊液LA、NLR对鉴别诊断BM与VM有一定的价值,其中NLR相比LA诊断BM敏感度更高。OBJECTIVE To analyze the value of combined detection of cerebrospinal fluid lactate(LA) and neutrophil-to-lymphocyte ratio(NLR) in differential diagnosis of bacterial meningitis(BM) and viral meningitis(VM). METHODS From Jan 2015 to Dec 2017, totally 50 children with BM and 50 children with VM who were eligible for inclusion criteria were extracted from the Maternal and Child Health Hospital of Zibo.The clinical symptoms and signs of the two groups of children were recorded, the cerebrospinal fluid LA level and NLR were determined, the peripheral blood white blood cell(WBC) counts and absolute counts of neutrophils and lymphocytes of the children were detected by using whole blood cell automatic analyzer, the NLR was calculated, and the sensitivity and specificity of peripheral blood NLR, cerebrospinal fluid LA and NLR in diagnosis of BM were analyzed by means of the receiver-operating-characteristic(ROC) curve. RESULTS The proportion of the children with headache of the BM group was 14.00%, significantly lower than that of the VM group;the proportions of the children with disturbance of consciousness and imaging changes of the BM group were respectively 14.00% and 72.00%, significantly higher than those of the VM group(P<0.05).The cerebrospinal fluid LA of the BM group was(4.25±1.91)mmol/L, significantly higher than that of the VM group, and the NLR of the BM group was(6.16±2.43), significantly higher than that of the VM group.The levels of peripheral blood WBC and neutrophils of the BM group were respectively(15.53±2.85)×10^9/L and(11.15±2.23)×10^9/L, significantly higher than those of the VM group, and the NLR of the BM group was(4.10±0.61), significantly higher than that of the VM group(P<0.05).The sensitivity and specificity were respectively 90.00% and 66.00% in diagnosis of BM when the cerebrospinal fluid was more than 2.01 mmol/L;the sensitivity and specificity were respectively 80.00% and 92.00% in diagnosis of BM when the cerebrospinal fluid NLR was more than 3.94.The area under ROC curve of the

关 键 词：脑脊液 乳酸 中性粒细胞淋巴细胞比值 细菌性脑膜炎 病毒性脑膜炎 患儿 

分 类 号：R725.1[医药卫生—儿科]