Leib S L, Boscacci R, Gratzl O, Zimmerli W
Division of Infectious Diseases and the Clinic of Neurosurgery, University Hospitals Basel, Switzerland.
Clin Infect Dis. 1999 Jul;29(1):69-74. doi: 10.1086/520184.
The value of cerebrospinal fluid (CSF) lactate level and CSF/blood glucose ratio for the identification of bacterial meningitis following neurosurgery was assessed in a retrospective study. During a 3-year period, 73 patients fulfilled the inclusion criteria and could be grouped by preset criteria in one of three categories: proven bacterial meningitis (n = 12), presumed bacterial meningitis (n = 14), and nonbacterial meningeal syndrome (n = 47). Of 73 patients analyzed, 45% were treated with antibiotics and 33% with steroids at the time of first lumbar puncture. CSF lactate values (cutoff, 4 mmol/L), in comparison with CSF/blood glucose ratios (cutoff, 0.4), were associated with higher sensitivity (0.88 vs. 0.77), specificity (0.98 vs. 0.87), and positive (0.96 vs. 0.77) and negative (0.94 vs. 0.87) predictive values. In conclusion, determination of the CSF lactate value is a quick, sensitive, and specific test to identify patients with bacterial meningitis after neurosurgery.
一项回顾性研究评估了脑脊液（CSF）乳酸水平和脑脊液/血糖比值在神经外科手术后细菌性脑膜炎诊断中的价值。在3年期间，73例患者符合纳入标准，并可根据预设标准分为以下三类之一：确诊细菌性脑膜炎（n = 12）、疑似细菌性脑膜炎（n = 14）和非细菌性脑膜综合征（n = 47）。在分析的73例患者中，45%在首次腰椎穿刺时接受了抗生素治疗，33%接受了类固醇治疗。与脑脊液/血糖比值（临界值为0.4）相比，脑脊液乳酸值（临界值为4 mmol/L）具有更高的敏感性（0.88对0.77）、特异性（0.98对0.87）以及阳性预测值（0.96对0.77）和阴性预测值（0.94对0.87）。总之，测定脑脊液乳酸值是一种快速、敏感且特异的检测方法，可用于识别神经外科手术后细菌性脑膜炎患者。
