Sanaei Dashti Anahita, Alizadeh Shekoofan, Karimi Abdullah, Khalifeh Masoomeh, Shoja Seyed Abdolmajid
Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz Pediatric Infectious Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Medicine (Baltimore). 2017 Sep;96(35):e7637. doi: 10.1097/MD.0000000000007637.
There are many difficulties distinguishing bacterial from viral meningitis that could be reasonably solved using biomarkers. The aim of this study was to evaluate lactate, procalcitonin (PCT), ferritin, serum-CRP (C-reactive protein), and other known biomarkers in differentiating bacterial meningitis from viral meningitis in children.All children aged 28 days to 14 years with suspected meningitis who were admitted to Mofid Children's Hospital, Tehran, between October 2012 and November 2013, were enrolled in this prospective cross-sectional study. Children were divided into 2 groups of bacterial and viral meningitis, based on the results of cerebrospinal fluid (CSF) culture, polymerase chain reaction, and cytochemical profile. Diagnostic values of CSF parameters (ferritin, PCT, absolute neutrophil count [ANC], white blood cell count, and lactate) and serum parameters (PCT, ferritin, CRP, and erythrocyte sedimentation rate [ESR]) were evaluated.Among 50 patients with meningitis, 12 were diagnosed with bacterial meningitis. Concentrations of all markers were significantly different between bacterial and viral meningitis, except for serum (P = .389) and CSF (P = .136) PCT. The best rates of area under the receiver operating characteristic (ROC) curve (AUC) were achieved by lactate (AUC = 0.923) and serum-CRP (AUC = 0.889). The best negative predictive values (NPV) for bacterial meningitis were attained by ANC (100%) and lactate (97.1%).The results of our study suggest that ferritin and PCT are not strong predictive biomarkers. A combination of low CSF lactate, ANC, ESR, and serum-CRP could reasonably rule out the bacterial meningitis.
使用生物标志物可以合理解决区分细菌性脑膜炎和病毒性脑膜炎的诸多难题。本研究旨在评估乳酸、降钙素原（PCT）、铁蛋白、血清C反应蛋白（CRP）以及其他已知生物标志物在鉴别儿童细菌性脑膜炎和病毒性脑膜炎中的作用。2012年10月至2013年11月期间，所有年龄在28天至14岁、因疑似脑膜炎入住德黑兰莫菲德儿童医院的儿童均纳入本前瞻性横断面研究。根据脑脊液（CSF）培养、聚合酶链反应和细胞化学特征的结果，将儿童分为细菌性脑膜炎和病毒性脑膜炎两组。评估了脑脊液参数（铁蛋白、PCT、绝对中性粒细胞计数[ANC]、白细胞计数和乳酸）和血清参数（PCT、铁蛋白、CRP和红细胞沉降率[ESR]）的诊断价值。在50例脑膜炎患者中，12例被诊断为细菌性脑膜炎。除血清（P = 0.389）和脑脊液（P = 0.136）PCT外，所有标志物的浓度在细菌性脑膜炎和病毒性脑膜炎之间均有显著差异。乳酸（AUC = 0.923）和血清CRP（AUC = 0.889）在受试者工作特征（ROC）曲线下面积（AUC）方面表现最佳。ANC（100%）和乳酸（97.1%）对细菌性脑膜炎的阴性预测值（NPV）最佳。我们的研究结果表明，铁蛋白和PCT不是强有力的预测生物标志物。低脑脊液乳酸、ANC、ESR和血清CRP的组合可以合理排除细菌性脑膜炎。
