首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >Elevated cerebrospinal fluid levels of glutamate in children with bacterial meningitis as a predictor of the development of seizures or other adverse outcomes.
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Elevated cerebrospinal fluid levels of glutamate in children with bacterial meningitis as a predictor of the development of seizures or other adverse outcomes.

机译:细菌性脑膜炎患儿脑脊液中谷氨酸水平的升高可预测癫痫发作或其他不良后果的发生。

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OBJECTIVE: Evaluation of elevated cerebrospinal fluid levels of glutamate in children with bacterial meningitis as a predictor of seizures or other adverse outcomes. DESIGN: Prospective cohort study with controls. SETTING: A 36-bed pediatric intensive care unit and primary pediatric referral center. PATIENTS: From 1999 to 2001, a total of 55 patients, between the ages of 0 and 18 yrs, with lumbar punctures performed for suspected meningitis. MEASUREMENTS AND MAIN RESULTS: A total of 23 patients had bacterial meningitis confirmed by cerebrospinal fluid/blood culture and elevated cerebrospinal fluid white blood cell counts, and 32 patients, who tested negative, were included as controls. The median age for the patients with meningitis was 1.0 yr (range, 0.0-15.2 yrs), and in the culture-negative group (control group), the median age was 0.3 yrs (range, 0.0-17.0 yrs). The average cerebrospinal fluid white blood cell count was 2707 +/- 3897 in the group with bacterial infection, whereas in the control group, the average was 148 +/- 259 (p < .01). Patients with bacterial meningitis had a mean cerebrospinal fluid glutamate level of 60.5 +/- 88.4 mol/L, whereas the mean cerebrospinal fluid glutamate level in the control group was 4.9 +/- 11.0 mol/L (p < .01). However, only 10 of 23 children with bacterial meningitis had a second lumbar puncture performed during the study. There was no correlation between the cerebrospinal fluid white blood cell count and cerebrospinal fluid glutamate levels in either the study or control patients. None of the control patients developed seizures or neurologic deficits, despite some patients having elevated glutamate levels. However, four patients with bacterial meningitis developed seizures after admission to the hospital, and ten were discharged with at least some neurologic sequelae attributable to their infection. Two out of the three who developed seizures and had a repeat lumbar puncture demonstrated persistent elevation of cerebrospinal fluid glutamate levels. In addition, 70% of patients (7 of 10) with Streptococcus pneumoniae meningitis developed neurologic complications (p = .04). CONCLUSIONS: Bacterial meningitis in children causes an increase in cerebrospinal fluid glutamate that in many cases persists over time. However, in this limited study, neither higher nor persistent elevation of cerebrospinal fluid glutamate levels is predictive of which patients might develop seizures or other apparent immediate adverse outcomes after invasive infection. The responsible organism seems to have far more significance in predicting the development of adverse sequelae.
机译:目的:评估细菌性脑膜炎患儿脑脊液中谷氨酸水平的升高,作为癫痫发作或其他不良后果的预测指标。设计:前瞻性队列研究与对照。地点:一个有36张床的儿科重症监护室和初级儿科转诊中心。患者:从1999年至2001年,共有55例0至18岁的患者因怀疑脑膜炎而进行了腰椎穿刺术。测量和主要结果:总共23例通过脑脊液/血液培养确认的细菌性脑膜炎和脑脊液白细胞计数升高,并且32例呈阴性的患者被包括在内。脑膜炎患者的中位年龄为1.0岁(范围为0.0-15.2岁),而阴性培养组(对照组)的中位年龄为0.3岁(范围为0.0-17.0岁)。细菌感染组的平均脑脊液白细胞计数为2707 +/- 3897,而对照组为148 +/- 259(p <.01)。细菌性脑膜炎患者的平均脑脊液谷氨酸水平为60.5 +/- 88.4 mol / L,而对照组的平均脑脊液谷氨酸水平为4.9 +/- 11.0 mol / L(p <.01)。但是,在研究过程中,细菌性脑膜炎的23名儿童中只有10名进行了第二次腰椎穿刺。在研究或对照患者中,脑脊液白细胞计数与脑脊液谷氨酸水平之间没有相关性。尽管有些患者的谷氨酸水平升高,但没有对照组患者出现癫痫发作或神经功能缺损。但是,有4名细菌性脑膜炎患者入院后出现癫痫发作,其中10名因出院感染而至少有一些神经系统后遗症出院。三分之二的癫痫发作并反复进行腰椎穿刺表明脑脊液谷氨酸水平持续升高。此外,70%的肺炎链球菌脑膜炎患者(共10例中的7例)发生了神经系统并发症(p = .04)。结论:儿童细菌性脑膜炎导致脑脊液谷氨酸的增加,在许多情况下随着时间的推移持续存在。然而,在这项有限的研究中,脑脊液谷氨酸水平的升高或持续升高均不能预测侵入性感染后哪些患者可能发生癫痫发作或其他明显的即时不良后果。负责任的有机体在预测不良后遗症的发生方面似乎具有更大的意义。

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