血清降钙素原及其他生物标志物用于鉴别细菌性脑膜炎和无菌性脑膜炎。

Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis.

作者信息

Dubos Francois, Moulin Florence, Gajdos Vincent, De Suremain Nathalie, Biscardi Sandra, Lebon Pierre, Raymond Josette, Breart Gerard, Gendrel Dominique, Chalumeau Martin

机构信息

Clinical Epidemiology Unit, Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Paris Descartes University, and INSERM U149, Paris, France.

出版信息

J Pediatr. 2006 Jul;149(1):72-6. doi: 10.1016/j.jpeds.2006.02.034.

DOI:10.1016/j.jpeds.2006.02.034

PMID:16860131

Abstract

OBJECTIVE

To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED).

STUDY DESIGN

All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison.

RESULTS

Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>/=0.5 ng/mL) and CSF protein (>/=0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively.

CONCLUSION

PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.

摘要

目的

确定在急诊科（ED）中最能区分细菌性脑膜炎和无菌性脑膜炎的生物学检测方法。

研究设计

1995年至2004年因细菌性脑膜炎住院的所有儿童以及2000年至2004年因无菌性脑膜炎住院的所有儿童均纳入一项回顾性队列研究。确定了急诊科可获得的血液（C反应蛋白、降钙素原[PCT]、白细胞[WBC]计数、中性粒细胞计数）和脑脊液（CSF）检查结果（蛋白质、葡萄糖、WBC计数、中性粒细胞计数）的预测价值。通过单变量和多变量分析以及ROC曲线比较确定具有最佳预测价值的检测方法。

结果

纳入的167例患者中，21例患有细菌性脑膜炎。脑脊液革兰氏染色和细菌抗原检测的灵敏度分别为86%和60%。PCT（≥0.5 ng/mL）和脑脊液蛋白（≥0.5 g/L）是最佳的生物学检测方法，灵敏度分别为89%和86%，特异度分别为89%和78%，校正比值比分别为108（95%CI，15 - 772）和34（95%CI，5 - 217），ROC曲线下面积分别为0.95和0.93。