Arditi M, Manogue K R, Caplan M, Yogev R
Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois.
J Infect Dis. 1990 Jul;162(1):139-47. doi: 10.1093/infdis/162.1.139.
In prospective studies, tumor necrosis factor (TNF alpha) was detected in cerebrospinal fluid (CSF) of 33 of 38 children with bacterial meningitis (BM) but in none of 15 with viral meningitis/encephalitis (P less than .001). BM CSF TNF alpha (less than 35 to greater than 25,500 pg/ml) correlated with CSF bacterial density (P less than .01), CSF protein (P less than .001), endotoxin (LPS) in gram-negative disease (P less than .01), and consecutive febrile hospital days (P less than .001); initial CSF TNF alpha greater than 1000 pg/ml was associated with seizures (P less than .05). Only 5 children with BM (13%) had detectable plasma TNF alpha activity on admission. A higher proportion who died had detectable plasma TNF alpha activity compared with survivors (3/4 vs. 2/34, P less than .005). Platelet-activating factor (PAF) in CSF was higher in 19 children with Haemophilus influenzae meningitis than in 17 controls (P less than .01) and correlated with bacterial density (P less than .01), CSF LPS (P less than .01), CSF TNF alpha levels (P less than .01), and the Herson-Todd severity score (P less than .01). Elevated CSF TNF alpha and PAF are often present in children with BM and are associated with seizures and severity of disease. Detectable CSF TNF alpha appears to distinguish BM from viral meningitis.
在前瞻性研究中，38例细菌性脑膜炎（BM）患儿中有33例脑脊液（CSF）中检测到肿瘤坏死因子（TNFα），而15例病毒性脑膜炎/脑炎患儿中均未检测到（P<0.001）。BM患儿脑脊液TNFα水平（低于35至高于25500 pg/ml）与脑脊液细菌密度（P<0.01）、脑脊液蛋白（P<0.001）、革兰阴性菌感染时的内毒素（LPS）（P<0.01）以及连续发热住院天数（P<0.001）相关；初始脑脊液TNFα大于1000 pg/ml与癫痫发作相关（P<0.05）。仅5例BM患儿（13%）入院时血浆TNFα活性可检测到。与幸存者相比，死亡患儿血浆TNFα活性可检测到的比例更高（3/4 vs. 2/34，P<0.005）。19例流感嗜血杆菌脑膜炎患儿脑脊液中的血小板活化因子（PAF）高于17例对照患儿（P<0.01），且与细菌密度（P<0.01）、脑脊液LPS（P<0.01）、脑脊液TNFα水平（P<0.01）以及Herson-Todd严重程度评分（P<0.01）相关。脑脊液TNFα和PAF升高在BM患儿中常出现，并与癫痫发作和疾病严重程度相关。可检测到的脑脊液TNFα似乎可将BM与病毒性脑膜炎区分开来。
