Khosroshahi Nahid, Alizadeh Parastoo, Khosravi Mehdi, Salamati Peyman, Kamrani Kamyar
Department of Pediatric Neurology, Tehran University of Medical Sciences, Tehran, Iran.
Department of Medicine, University of Kentucky, Lexington, Kentucky, USA.
Iran J Child Neurol. 2015 Winter;9(1):31-6.
Altered mental status is a common cause of intensive care unit admission in children. Differentiating structural causes of altered mental status from metabolic etiologies is of utmost importance in diagnostic approach and management of the patients. Among many biomarkers proposed to help stratifying patients with altered mental status, spinal fluid lactate dehydrogenase appears to be the most promising biomarker to predict cellular necrosis.
MATERIALS & METHODS: In this cross sectional study we measured spinal fluid level of lactate dehydrogenase in children 2 months to 12 years of age admitted to a single center intensive care unit over one year. Spinal fluid level of lactate dehydrogenase in 40 pediatric cases of febrile seizure was also determined as the control group.
The study group included 35 boys (58.3%) and 25 girls (41.7%). Their mean age was 2.7+/-3 years and their mean spinal fluid lactate dehydrogenase level was 613.8+/-190.4 units/liter. The control group included 24 boys (55.8%) and 19 girls (44.2%). Their mean age was 1.3+/-1.2 years and their mean spinal fluid lactate dehydrogenase level was 18.9+/-7.5 units/liter. The mean spinal fluid lactate dehydrogenase level in children with abnormal head CT scan was 246.3+/-351.5 units/liter compared to 164.5+/-705.7 in those with normal CT scan of the head (p=0.001).
Spinal fluid lactate dehydrogenase level is useful in differentiating structural and metabolic causes of altered mental status in children.
意识状态改变是儿童入住重症监护病房的常见原因。在对患者的诊断方法和管理中，区分意识状态改变的结构性原因与代谢性病因至关重要。在众多旨在帮助对意识状态改变的患者进行分层的生物标志物中，脑脊液乳酸脱氢酶似乎是预测细胞坏死最有前景的生物标志物。
在这项横断面研究中，我们测量了在一年时间里入住单一中心重症监护病房的2个月至12岁儿童的脑脊液乳酸脱氢酶水平。还测定了40例小儿热性惊厥病例的脑脊液乳酸脱氢酶水平作为对照组。
研究组包括35名男孩（58.3%）和25名女孩（41.7%）。他们的平均年龄为2.7±3岁，平均脑脊液乳酸脱氢酶水平为613.8±190.4单位/升。对照组包括24名男孩（55.8%）和19名女孩（44.2%）。他们的平均年龄为1.3±1.2岁，平均脑脊液乳酸脱氢酶水平为18.9±7.5单位/升。头部CT扫描异常的儿童平均脑脊液乳酸脱氢酶水平为246.3±351.5单位/升，而头部CT扫描正常的儿童为164.5±705.7单位/升（p=0.001）。
脑脊液乳酸脱氢酶水平有助于区分儿童意识状态改变的结构性和代谢性原因。
