Stearman M, Southgate H J
Department of Chemical Pathology, Worthing Hospital, West Sussex, UK.
Ann Clin Biochem. 1994 May;31 ( Pt 3):255-61. doi: 10.1177/000456329403100307.
Cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP), tumour necrosis factor alpha (TNF), interleukin-6 (IL-6), total protein (TP) and white cell count with differential (WCC) have been measured in 24 patients presenting with acute bacterial or viral meningitis and also in a non-infected, non-inflamed control group (n = 24). In acute viral meningitis, CRP levels were not raised when compared to controls and there was a discordance between high levels of the primary inflammatory mediators (IL-6 and TNF) and the low measured CRP levels. CRP levels were raised in cases of bacterial meningitis. A concentration of 100 ng/mL CRP had a sensitivity of 87% for bacterial meningitis. TNF concentrations in the CSF were significantly raised in cases of acute bacterial meningitis (P < 0.001). Smaller but variable elevations were seen in the patients with acute viral meningitis. One patient, who succumbed to bacterial infection, showed low CSF levels of CRP, TNF and WCC but an elevated IL-6 concentration. Another, presenting with low CSF WCC, had raised concentrations of CRP, TNF and IL-6 which pointed to the correct diagnosis of acute bacterial meningitis. The development of methods yielding rapid analysis for these cytokines together with a sensitive assay for CRP in CSF would be a useful adjunct to conventional investigation.
对24例急性细菌性或病毒性脑膜炎患者以及一个未感染、无炎症的对照组（n = 24）测定了脑脊液（CSF）中C反应蛋白（CRP）、肿瘤坏死因子α（TNF）、白细胞介素-6（IL-6）、总蛋白（TP）和白细胞计数及分类（WCC）。在急性病毒性脑膜炎中，与对照组相比CRP水平未升高，主要炎症介质（IL-6和TNF）水平高与测得的低CRP水平之间存在不一致。细菌性脑膜炎病例中CRP水平升高。CRP浓度为100 ng/mL时对细菌性脑膜炎的敏感性为87%。急性细菌性脑膜炎病例中脑脊液TNF浓度显著升高（P < 0.001）。急性病毒性脑膜炎患者中可见较小但变化不定的升高。一名死于细菌感染的患者脑脊液中CRP、TNF和WCC水平低，但IL-6浓度升高。另一名脑脊液WCC低的患者CRP、TNF和IL-6浓度升高，这指向急性细菌性脑膜炎的正确诊断。开发能对这些细胞因子进行快速分析以及对脑脊液中CRP进行灵敏检测的方法将是对传统检查的有益辅助。
