Institut fuer Klinische Chemie und Laboratoriumsdiagnostik, FSU Jena, Germany.
Acta Neurochir (Wien). 2011 Sep;153(9):1797-805. doi: 10.1007/s00701-011-1079-1. Epub 2011 Jul 19.
Generally accepted reference values in CSF diagnostics are not valid in cerebrospinal fluid (CSF) containing large amounts of blood. Residual blood may obscure ventriculitis as diagnostics largely depend on parameters such as cell count, lactic acid and total protein measurement. We sought to improve the diagnostics by evaluating a cytokine panel and soluble CD62L as markers of ventriculitis. In addition, we tested an algorithm of established parameters to predict ventriculitis in a specific patient collective.
Analysis was performed on ventricular CSF samples from 50 consecutive patients. Gram staining, microbiological culture, total cell count, total protein and CD62L expression on neutrophil granulocytes were analysed immediately. Cytokines and soluble CD62L were measured by flow cytometry.
Positive culture was detected in ten patients. Of all parameters tested only IL1-beta, IL8 and CD62L on neutrophils were significantly different between culture-positive and -negative patients. The highest predictive value was obtained when analysing IL1-beta. The predictive value of a parameter combination (IL6 in CSF, C-reactive protein and leukocytes in periphereal blood) was comparable to IL1-beta. Half of the patients in this analysis were identified as culture positive because of the lack of inflammatory response.
IL1-beta and perhaps also IL8 provide very good analytical performance when looking for ventriculitis in patients with residual blood in CSF. Turn-around time is short, and results could be reported within 1 h for 24 h a day. In some patients application of glucocorticoids may result in restricted inflammatory response. Even in these patients IL1-beta provides a reliable parameter for the immediate diagnosis of ventriculitis.
在含有大量血液的脑脊液（CSF）中，脑脊液诊断中普遍接受的参考值并不适用。残留的血液可能会掩盖脑室炎，因为诊断在很大程度上取决于细胞计数、乳酸和总蛋白测量等参数。我们试图通过评估细胞因子谱和可溶性 CD62L 作为脑室炎标志物来改善诊断。此外，我们还测试了一种算法，以预测特定患者群体中的脑室炎。
对 50 例连续患者的脑室 CSF 样本进行了分析。立即分析革兰氏染色、微生物培养、总细胞计数、总蛋白和中性粒细胞上的 CD62L 表达。通过流式细胞术测量细胞因子和可溶性 CD62L。
在 10 名患者中检测到阳性培养。在所有测试的参数中，只有白细胞介素 1-β、白细胞介素 8 和中性粒细胞上的 CD62L 在培养阳性和阴性患者之间存在显著差异。分析白细胞介素 1-β 时获得了最高的预测值。参数组合（CSF 中的白细胞介素 6、C 反应蛋白和外周血中的白细胞）的预测值与白细胞介素 1-β相当。在这项分析中，有一半的患者因缺乏炎症反应而被鉴定为培养阳性。
当在 CSF 中有残留血液的患者中寻找脑室炎时，白细胞介素 1-β 可能还有白细胞介素 8 提供了非常好的分析性能。周转时间短，每天 24 小时内可以在 1 小时内报告结果。在一些患者中，应用糖皮质激素可能会导致炎症反应受限。即使在这些患者中，白细胞介素 1-β 也为立即诊断脑室炎提供了可靠的参数。
