胎龄和日龄对新生儿脑脊液参数指标的影响

摘要

Objective To study the influence of gestational age (GA) and postnatal age on neonatal cerebrospinal fluid parameters.Method From January 2013 to December 2015,the results of WBC counts,glucose and protein concentrations of cerebro-spinal fluid(CSF) were collected from neonates admitted to neonatal department of our hospitals.The neonates were assigned into different groups according to their GA and postnatal age.The CSF parameters were compared between different groups,and the changes of CSF parameters were analyzed.STATA 12.0 software was used for statistical analysis.Result A total of 1 410 infants were included.516 (36.6％) cases were preterm infants.1 208 cases (85.7％) received antibiotics before lumbar puncture.WBC counts in CSF between preterm and term infants showed no significant differences (upper reference limit,12.5 × 106/L).CSF glucose in term infants (lower reference limit,1.8 mmol/L) was higher than preterm infants (lower reference limit,1.6 mmol/L).CSF protein in preterm infants (upper reference limit,226.6 mg/ dl) was significantly higher than term infants (upper reference limit,140.3 mg/dl).CSF WBC counts decreased with the growth of postnatal age in preterm infants (regression coefficients-0.030,P=0.035).CSF protein also declined significantly with the increase of postnatal age in term infants (regression coefficients-1.254,P＜0.001).CSF glucose showed no significant decrease with the increase of postnatal age (regression coefficients-0.009,P=0.012).Conclusion GA and postnatal age did not produce an effect on WBC counts of CSF.The preterm infants had lower glucose level and higher protein level in CSF.CSF protein declined significantly with the increase of GA and postnatal age.%目的 探讨胎龄和日龄对新生儿脑脊液白细胞计数、葡萄糖、蛋白质含量测定值的影响.方法 收集2013年1月至2015年12月复旦大学附属儿科医院新生儿科和深圳市龙岗中心医院新生儿科住院患儿的脑脊液白细胞计数、葡萄糖、蛋白质含量结果,按照胎龄和生后日龄分组,对比各组患儿脑脊液参数,并分析各检测指标随胎龄和生后日龄的变化.应用STATA 12.0统计软件进行数据分析.结果 共1 410例新生儿纳入研究,腰椎穿刺前使用抗生素1 208例(85.7％);早产儿516例(36.6％).早产儿与足月儿脑脊液白细胞计数差异无统计学意义(P＞0.05),上限值均为12.5×106/L;早产儿脑脊液葡萄糖水平低于足月儿(下限值:早产儿1.6 mmol/L,足月儿1.8 mmol/L),脑脊液蛋白质含量高于足月儿(上限值:早产儿226.6 mg/dl,足月儿140.3 mg/dl).早产儿脑脊液白细胞计数随生后日龄增加而下降(回归系数-0.030,P=0.035);足月儿脑脊液蛋白质含量随生后日龄增加而下降(回归系数-1.254,P＜0.001),脑脊液葡萄糖水平随生后日龄增加下降不明显(回归系数-0.009,P=0.0 12).结论 新生儿脑脊液白细胞计数不受胎龄和日龄影响;脑脊液葡萄糖水平早产儿较足月儿低;脑脊液蛋白质含量随胎龄及生后日龄增加而下降.