O'Brien Nicole F, Chetcuti Karen, Fonseca Yudy, Vidal Lorenna, Raghavan Prashant, Postels Douglas G, Chimalizeni Yamikani, Ray Stephen, Seydel Karl B, Taylor Terrie E
Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States.
Department of Radiology, College of Medicine, Chichiri, Blantyre, Malawi.
J Pediatr Intensive Care. 2021 Aug 10;12(4):278-288. doi: 10.1055/s-0041-1732444. eCollection 2023 Dec.
Cerebral metabolic energy crisis (CMEC), often defined as a cerebrospinal fluid (CSF) lactate: pyruvate ratio (LPR) >40, occurs in various diseases and is associated with poor neurologic outcomes. Cerebral malaria (CM) causes significant mortality and neurodisability in children worldwide. Multiple factors that could lead to CMEC are plausible in these patients, but its frequency has not been explored. Fifty-three children with CM were enrolled and underwent analysis of CSF lactate and pyruvate levels. All 53 patients met criteria for a CMEC (median CSF LPR of 72.9 [interquartile range [IQR]: 58.5-93.3]). Half of children met criteria for an ischemic CMEC (median LPR of 85 [IQR: 73-184]) and half met criteria for a nonischemic CMEC (median LPR of 60 [IQR: 54-79]. Children also underwent transcranial doppler ultrasound investigation. Cerebral blood flow velocities were more likely to meet diagnostic criteria for low flow (<2 standard deviation from normal) or vasospasm in children with an ischemic CMEC (73%) than in children with a nonischemic CMEC (20%, = 0.04). Children with an ischemic CMEC had poorer outcomes (pediatric cerebral performance category of 3-6) than those with a nonischemic CMEC (46 vs. 22%, = 0.03). CMEC was ubiquitous in this patient population and the processes underlying the two subtypes (ischemic and nonischemic) may represent targets for future adjunctive therapies.
脑代谢能量危机（CMEC）通常被定义为脑脊液（CSF）乳酸与丙酮酸比值（LPR）>40，见于多种疾病，并与不良神经学预后相关。脑型疟疾（CM）在全球儿童中可导致显著的死亡率和神经功能障碍。在这些患者中，多种可能导致CMEC的因素看似合理，但其发生率尚未得到研究。53例CM患儿入组并接受脑脊液乳酸和丙酮酸水平分析。所有53例患者均符合CMEC标准（脑脊液LPR中位数为72.9[四分位间距[IQR]：58.5 - 93.3]）。一半儿童符合缺血性CMEC标准（LPR中位数为85[IQR：73 - 184]），另一半符合非缺血性CMEC标准（LPR中位数为60[IQR：54 - 79]）。患儿还接受了经颅多普勒超声检查。与非缺血性CMEC患儿（20%，P = 0.04）相比，缺血性CMEC患儿的脑血流速度更有可能符合低血流（低于正常2个标准差）或血管痉挛的诊断标准（73%）。缺血性CMEC患儿的预后（小儿脑功能分类为3 - 6级）比非缺血性CMEC患儿差（46%对22%，P = 0.03）。CMEC在该患者群体中普遍存在，两种亚型（缺血性和非缺血性）的潜在机制可能代表未来辅助治疗的靶点。
