Song Ji Yeon, Nam Sang Ook, Kim Young A, Kim Kyung Min, Lyu Soo Young, Ko Ara, Kim Young Mi, Yeon Gyu Min, Lee Yun-Jin
Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Pediatr Int. 2018 Sep;60(9):855-861. doi: 10.1111/ped.13658.
Lack of cerebrospinal fluid (CSF) pleocytosis has been reported in some children with enteroviral meningitis (EVM). The aim of this paper was to investigate the clinical spectrum and related factors in EVM with CSF non-pleocytosis.
The databases of children diagnosed with EVM on CSF polymerase chain reaction between 2011 and 2014 were retrospectively reviewed. CSF pleocytosis was defined at each age using the criteria. Clinical and laboratory variables were compared between patients with CSF pleocytosis and non-pleocytosis.
Of the 802 children of EVM, 25.4% (204/802) had CSF non-pleocytosis. In particular, CSF non-pleocytosis was found in 63.3% of the neonates versus in 22.2% of the children aged ≥1 year old, indicating that the ratio of CSF non-pleocytosis had a negative correlation with age (P < 0.001). As the main symptoms, fever (91.8% vs 86.8%, P = 0.038), headache (80.3% vs 63.7%, P < 0.001), and vomiting (75.9% vs 61.8%, P < 0.001) were significantly more frequent in CSF pleocytosis than in CSF non-pleocytosis. Patients with CSF non-pleocytosis had much lower peripheral leukocytosis (10 656 ± 3,662 vs 12 403 ± 4,207/mm , P = 0.014) and C-reactive protein (0.7±0.8 vs 1.2±1.5 mg/dL, P < 0.001), and earlier lumbar puncture <24 h after onset (42.6% vs 21.4%, p<0.001). No significant difference during the summer and autumn months was seen between the two groups (76.9% vs 81.9%, P = 0.169).
CSF non-pleocytosis in childhood EVM was frequently observed, especially in young infants, regardless of season. We propose that CSF PCR testing for enterovirus can be helpful to recognize EVM in children with CSF non-pleocytosis.
已有报道称，部分患肠道病毒脑膜炎（EVM）的儿童脑脊液（CSF）中无细胞增多现象。本文旨在研究脑脊液无细胞增多的EVM的临床特征及相关因素。
回顾性分析2011年至2014年间因脑脊液聚合酶链反应诊断为EVM的儿童数据库。根据各年龄段标准定义脑脊液细胞增多情况。比较脑脊液有细胞增多和无细胞增多患者的临床及实验室变量。
在802例EVM患儿中，25.4%（204/802）脑脊液无细胞增多。特别是，63.3%的新生儿脑脊液无细胞增多，而≥1岁儿童中这一比例为22.2%，表明脑脊液无细胞增多的比例与年龄呈负相关（P<0.001）。作为主要症状，脑脊液有细胞增多患儿中发热（91.8%对86.8%，P=0.038）、头痛（80.3%对63.7%，P<0.001）和呕吐（75.9%对61.8%，P<0.001）的发生率明显高于脑脊液无细胞增多患儿。脑脊液无细胞增多的患者外周白细胞增多（10656±3662对12403±4207/mm³，P=0.014）和C反应蛋白水平（0.7±0.8对1.2±1.5mg/dL，P<0.001）更低，且发病后<24小时进行腰椎穿刺的比例更高（42.6%对21.4%，P<0.001）。两组在夏季和秋季月份无显著差异（76.9%对81.9%，P=0.169）。
儿童EVM中脑脊液无细胞增多现象常见，尤其是在小婴儿中，且与季节无关。我们认为，对肠道病毒进行脑脊液PCR检测有助于识别脑脊液无细胞增多患儿的EVM。
