Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.
Department of Geriatrics, Shandong Mental Health Center, Jinan, China.
Ann Med. 2021 Dec;53(1):885-889. doi: 10.1080/07853890.2021.1937692.
Although abnormal cerebrospinal fluid (CSF) protein can be used to predict the outcome of tuberculous meningitis (TBM) and diagnose TBM, normal CSF protein remains a concern in patients with TBM. This retrospective study aimed to assess the clinical characteristics associated with normal CSF protein, to resolve the dilemma of CSF protein in the management of childhood TBM.
Between January 2006 and December 2019, consecutive child patients (≤15 years old, a diagnosis of TBM, and tested for CSF protein) were included for analysis. CSF protein was tested on a chemistry analyzer using the pyrogallol red-molybdate method. Abnormal CSF protein was defined as >450 mg/L. Patient characteristics were collected from the electronic medical records. Then, characteristics associated with normal CSF protein were estimated in the study, using univariate and multivariate logistic regression analysis.
A total of 125 children who met the criteria were enrolled during the study period. Twenty-nine patients had a normal CSF protein and 96 had an abnormal CSF protein. Multivariate analysis (Hosmer-Lemeshow goodness-of-fit test: χ=2.486, df = 8, = .962) revealed that vomiting (age- and sex-adjusted OR = 0.253, 95% CI: 0.091, 0.701; = .008) and serum glucose (>5.08 mmol/L; age- and sex-adjusted OR = 0.119, 95% CI: 0.032, 0.443; = .002) were associated with the normal CSF protein in childhood TBM.
In suspected childhood TBM, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.KEY MESSAGESIn suspected childhood tuberculous meningitis, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.
尽管异常的脑脊液（CSF）蛋白可用于预测结核性脑膜炎（TBM）的结局并诊断 TBM，但 TBM 患者的 CSF 蛋白正常仍令人担忧。本回顾性研究旨在评估与 CSF 蛋白正常相关的临床特征，以解决 CSF 蛋白在儿童 TBM 管理中的困境。
2006 年 1 月至 2019 年 12 月，连续纳入（≤15 岁，诊断为 TBM，并检测 CSF 蛋白）的儿童患者进行分析。使用邻苯三酚红钼酸盐法在化学分析仪上检测 CSF 蛋白。异常 CSF 蛋白定义为>450mg/L。从电子病历中收集患者特征。然后，使用单变量和多变量逻辑回归分析估计与 CSF 蛋白正常相关的特征。
研究期间共纳入符合标准的 125 名儿童。29 名患者 CSF 蛋白正常，96 名患者 CSF 蛋白异常。多变量分析（Hosmer-Lemeshow 拟合优度检验：χ=2.486，df=8，=0.962）显示呕吐（年龄和性别校正的 OR=0.253，95%CI：0.091，0.701；=0.008）和血清葡萄糖（>5.08mmol/L；年龄和性别校正的 OR=0.119，95%CI：0.032，0.443；=0.002）与儿童 TBM 中 CSF 蛋白正常相关。
在疑似儿童 TBM 中，无呕吐或低血清葡萄糖的患者容易出现 CSF 蛋白正常。因此，当解释具有此类特征的儿童 CSF 蛋白水平时，需要进行仔细的临床评估。
在疑似儿童结核性脑膜炎中，无呕吐或低血清葡萄糖的患者容易出现 CSF 蛋白正常。因此，当解释具有此类特征的儿童 CSF 蛋白水平时，需要进行仔细的临床评估。
