de Almeida Sérgio Monteiro, Faria Fernanda Luize, de Goes Fontes Karina, Buczenko Gisele Maria, Berto Denize Bonato, Raboni Sonia Mara, Vidal Luine Rosele, Nogueira Meri Bordignon
Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
Clin Chem Lab Med. 2009;47(6):755-61. doi: 10.1515/CCLM.2009.160.
The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis.
CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF.
CSF LA was higher in bacterial meningitis 8.7 + 5.4 mmol/L compared with viral meningitis (1.9 + 0.6) and the other groups (p < 0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%.
CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity, specificity and predictive values. CSF LA can help in the cases with diagnostic uncertainty.
在某些情况下，鉴别细菌性脑膜炎和病毒性脑膜炎并不容易。脑脊液（CSF）分析对于明确诊断至关重要。目的是对细菌性脑膜炎、病毒性脑膜炎及其他中枢神经系统（CNS）疾病中的乳酸（LA）浓度进行定量，以评估脑脊液LA在鉴别细菌性脑膜炎和病毒性脑膜炎方面的诊断效用。
对来自七组的139份脑脊液样本进行脑脊液LA检测，这七组分别为：具有典型脑脊液的病毒性脑膜炎；脑脊液中存在中性粒细胞的疑似病毒性脑膜炎；细菌性脑膜炎；非感染性神经系统疾病；慢性脑膜炎；创伤性腰椎穿刺（LP）以及正常脑脊液。
细菌性脑膜炎患者的脑脊液LA水平为8.7 + 5.4 mmol/L，高于病毒性脑膜炎患者（1.9 + 0.6）及其他组（p < 0.0001）。病毒性脑膜炎组的脑脊液LA水平与非感染性中枢神经系统疾病组及慢性脑膜炎组相比无差异。脑脊液LA鉴别细菌性脑膜炎和病毒性脑膜炎的能力显示，敏感性为80%，特异性为97%，阳性预测值（PPV）为94%，阴性预测值（NPV）为89%。
脑脊液LA是鉴别细菌性脑膜炎和病毒性脑膜炎的有力检测方法，具有高敏感性、特异性和预测值。脑脊液LA有助于诊断存在不确定性的病例。
