Jakka S, Veena S, Rao A R M, Eisenhut M
Hinchingbrooke Hospital, Huntingdon, UK.
Infection. 2005 Aug;33(4):264-6. doi: 10.1007/s15010-005-5005-4.
There is a lack of data on the prognostic significance of changes in cerebrospinal fluid (CSF) parameters in tuberculous meningitis. Our objective was to determine whether changes in CSF parameters are associated with poor neurological outcome in tuberculous meningitis.
We conducted a prospective cohort study on children admitted with a diagnosis of tuberculous meningitis to Government General Hospital in Kakinada, India. On admission, CSF parameters including cell count with fraction of lymphocytes and neutrophil leukocytes, glucose, protein, lactic dehydrogenase (LDH), and adenosine deaminase (ADA) levels were measured. We compared levels in children with and without adverse neurological outcome.
A total of 26 children was enrolled over a 2-year period. Ten had an adverse neurological outcome. Six had permanent neurological deficits (four hemiplegia and two cranial nerve palsies), two a hydrocephalus and two died. There was no significant (p>0.05) difference in age, gender and in CSF parameters, including cell count, lymphocyte and neutrophil leukocyte fraction, glucose, protein, and LDH levels between patients with and without adverse neurological outcome. Patients with adverse outcome had with a mean (SD) of 17.1 (3.2) IU/l a significantly higher ADA level than patients without, who had a mean (SD) level of 11.3 (2.7) IU/l (p<0.001, t-test).
Adverse neurological outcome in childhood tuberculous meningitis is associated with increased cerebrospinal fluid adenosine deaminase levels.
关于结核性脑膜炎患者脑脊液（CSF）参数变化的预后意义，目前缺乏相关数据。我们的目的是确定CSF参数变化是否与结核性脑膜炎患者不良神经结局相关。
我们对印度卡基纳达政府总医院收治的诊断为结核性脑膜炎的儿童进行了一项前瞻性队列研究。入院时，测量CSF参数，包括淋巴细胞和中性粒细胞白细胞分数的细胞计数、葡萄糖、蛋白质、乳酸脱氢酶（LDH）和腺苷脱氨酶（ADA）水平。我们比较了有和没有不良神经结局的儿童的各项指标水平。
在2年期间共纳入26名儿童。其中10名出现不良神经结局。6名有永久性神经功能缺损（4名偏瘫和2名脑神经麻痹），2名患脑积水，2名死亡。有和没有不良神经结局的患者在年龄、性别以及CSF参数（包括细胞计数、淋巴细胞和中性粒细胞白细胞分数、葡萄糖、蛋白质和LDH水平）方面均无显著差异（p>0.05）。出现不良结局的患者ADA水平显著高于未出现不良结局的患者，前者平均（标准差）为17.1（3.2）IU/l，后者平均（标准差）水平为11.3（2.7）IU/l（p<0.001，t检验）。
儿童结核性脑膜炎的不良神经结局与脑脊液腺苷脱氨酶水平升高有关。
