摘要
目的观察降钙素原(PCT)检测在儿童化脓性脑膜炎中的临床意义。方法选取2012年3月-2015年3月医院化脓性脑膜炎患儿29例、病毒性脑膜炎患儿45例及健康体检儿童20名,于入院当天检测三组血常规、PCT水平及化脓性脑膜炎儿童、病毒性脑膜炎儿童行脑脊液常规、生化、病原学检查和头颅影像学、脑电图检查,且于治疗后3天、5天和7天检测三组PCT水平。建立ROC曲线,明确PCT诊断儿童化脓性脑膜炎灵敏度、特异性,计算阳性预测值、阴性预测值。结果入院当天化脓性脑膜炎PCT水平高于病毒性脑膜炎、健康体检者,差异具有统计学意义(P<0.05),病毒性脑膜炎与健康体检者差异无统计学意义。治疗第3、5天化脓性脑膜炎患者PCT水平分别为(3.105±2.041)ng/ml、(1.006±0.890)ng/ml高于病毒性脑膜炎患者(0.117±0.076)ng/ml、(0.115±0.082)ng/ml及健康体检者的(0.160±0.331)ng/ml、(0.160±0.331)ng/ml,差异均有统计学意义(P均<0.05),第7天与病毒性脑膜炎和健康体检差异无统计学意义。脑脊液白细胞计数>500×16/L与≤500×106/L者PCT水平差异无统计学意义,脑脊液蛋白升高与正常者比较、细菌培养阴性与培养阳性者比较、普通病情与重症患者比较,差异均无统计学意义。脑脊液葡萄糖含量降低患者PCT水平(3.65±0.76)ng/mL显著高于正常者(1.87±0.98)ng/ml(P<0.05)。PCT≥2ng/ml及≥10.0ng/ml特异性、阳性预测值高于PCT≥0.5ng/ml。结论 PCT水平检测有助于儿童化脓性脑膜炎早期诊断、病情评估与临床指导,且能避免单一指标对中枢神经系统感染类型的误诊,效果值得肯定。
OBJECTIVE To observe the clinical significance of procalcitonin（PCT）detection in children with purulent meningitis.METHODS From Mar.2012 to Mar.2015,29 children with purulent meningitis,45 children with viral meningitis and 20 healthy children were enrolled in this study.On admission day,three groups of blood routine and PCT levels were detected.And the children with purulent meningitis and viral meningitis were tested for routine,biochemical and etiological examinations,craniofacial imaging and electroencephalogram（EEG）,and PCT levels of three groups of subjects were examined at 3days,5days and 7days after treatment.The ROC curve was established to determine the sensitivity and specificity of PCT in the diagnosis of purulent meningitis in children,and positive predictive value and negative predictive value were calculated.RESULTS The level of PCT in patients with purulent meningitis on admission was significantly higher than that of viral meningitis and healthy children（P〈0.05）.There was no significant difference between viral meningitis and healthy subjects.The levels of PCT in patients with purulent meningitis were（3.105±2.041）ng/mL and（1.006±0.890）ng/mL at 3days and5 days after treatment,which were higher than（0.117±0.076）ng/mL and（0.115±0.082）ng/mL in viral meningitis and（0.160±0.331）ng/mL and（0.160±0.331）ng/mL in health children,and the differences were significant（P〈0.05）.Compared with those with viral meningitis and healthy subjects on day 7,the difference was not significant.The PCT level had not significant difference between the patients with CSF levels500×106/L and≤500×106/L.There were no significant difference between increased cerebrospinal fluid protein and normal,bacterial culture negative and culture positive,general condition and critically ill patients.The PCT level of patients with decreased cerebrospinal fluid glucose level was（3.65±0.76）ng/mL,which was higher than（1.87±0.98）ng/mL in normal,and the difference was significant（P〈0.05）.The specificity and positive predictive value of patients with PCT≥2ng/mL and PCT≥10.0ng/mL were higher than those with PCT≥0.5ng/mL.CONCLUSION The level of PCT can be helpful to the early diagnosis,evaluation and clinical guidance of purulent meningitis in children,and it can avoid the misdiagnosis of central nervous system infections by single index,so the effect is worthy of recognition.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第19期4518-4521,共4页
Chinese Journal of Nosocomiology
关键词
化脓性脑膜炎
儿童
降钙素原
诊断
Purulent meningitis
Children
Procalcitonin
Diagnosis
