【作者】 尚利宏；

【导师】 李亚蕊；

【作者基本信息】 山西医科大学 ， 儿科学， 2003， 硕士

【摘要】 目的 观察细菌性脑膜炎(BM)患儿脑脊液(CSF)中兴奋性氨基酸(EAA)谷氨酸(Glu)和天门冬氨酸(Asp)含量的变化，并探讨其在细菌性脑膜炎病理生理过程中的作用和临床意义。 方法 临床诊断为细菌性脑膜炎的40例患儿根据中枢神经系统功能障碍的程度分为轻度组(12例)和重度组(28例)，16例无神经系统疾病但具有腰穿指征的同期住院患儿为对照组，其中急性白血病(缓解期)8例，鼻窦炎5例，维生素D缺乏性手足搐搦症3例。所有患儿于入院当天应用抗菌素治疗前做腰穿留取脑脊液进行常规、生化及细菌学检查，另取脑脊液1-2ml立即置-30℃冰箱中保存用于Glu和Asp的测定。细菌性脑膜炎患儿于抗菌治疗三周后再次留取脑脊液复查常规、生化及细菌学检查，另取脑脊液标本冷冻待测。有神经系统后遗症的患儿出院三个月后复诊时第三次留取脑脊液标本，所有脑脊液标本详细标号登记后立即置-30℃冰箱中冷冻待测。实验使用日本岛津LC-6A高效液相色谱仪，采用OPA(邻苯二甲醛)、2-ME(2-巯基乙醇)柱前衍生氨基酸HPLC检测法测定CSF中Glu、Asp的浓度。 结果1.细菌性脑膜炎组CSF中Glu、AsP浓度明显高于对照组 (P值分别小于0.001和0.05)2.秉度细菌性脑膜炎患儿脑脊液中以u、AsP浓度明显高于轻度组患儿(P均小于0.001) 3.32例细菌性脑膜炎患儿经三周抗菌治步犷后8例病人CSF中Glu、AsP浓度持续升高，其中7例留有智力障碍、脑瘫、癫痛等神经系统后遗症，而另24例病人脑脊液中Glu、AsP含量较入院时明显下降，其中仅2人留有后遗症，经卡方检验者有显著差异性(犷=6.095，P<0.05)，6例有后遗症的患儿二个月后复诊时仍被发现脑脊液中Glu、AsP含量高于对照组水平。4.细菌性脑膜炎患儿CSF中Glu、AsP浓度‘J CSF中蛋白质含量呈正相关(r值分别为0.885和0.773，P值均小于0.001)，而与葡萄糖含量呈负相关(r值分别为一0.660和一0.615，P值均小于0.0])。 结论1.兴奋性氨基酸参与了细菌性脑膜炎的病理生理过程。2.测定CSF中兴奋性氨基酸浓度对细菌性脑膜炎病情严一甭程度的判断具有指一导意义。3.脑脊液中兴奋性氨基酸持续升高可以预，J之细菌性脑膜炎病人预后较差，日_兴奋毒作用较长时问地存在于有补}，经系统后遗症的病人。4.脑脊液中兴奋性氨基酸浓度的测定是评价细菌性脑膜炎脑损伤程度敏感和可靠的生化指标，i犷为EAA受体拮抗剂的临床应用提供了可靠的临床实验依据。更多还原

【Abstract】 Objectives To study the change of excitatory amino acids (EAA) glutamate (Glu) and aspartic (Asp) in cerebrospinal fluid (CSF)of children with bacterial meningitis and their function in pathophysiological mechanisms and clinical significance.Methods Aaccording to the clinical diagnosis criterion 40 patients of bacterial meningitis were chosen and classified into two groups, 28 cases of mild state, 12 cases of severe state , the clinical severity of the disease was assessed on admission. CSF control samples were obtained from 16 children without neurogenic diseases. The CSF samples were obtained by lumber puncture on admission before the beginning of antibiotic treatment and on the 21st day after the beginning of antibiotic treatment. The third group CSF samples were gotten from those who had poor clinical outcome three months since they were discharged from hospital. In addition to standard CSF investigations, including cell count ,cyctologic findings, protein analysis , glucose levels, theconcentration of glutamate and aspartate in the CSF was measured. All CSF samples were marked conscientiously and frozen immediately and stored for use at -30 in a refrigerator. The concentration of excitatory amino glutamate and aspartate was measured by high-performance liquid chromatography.Results 1. The CSF levels of excitatory amino glutamate and aspartate of children with bacterial meningitis were significantly higher than those of the controls (P<0.001 and 0.05). 2.The CSF levels of excitatory amino acid of patients with severe state were increased than those of mild state (P<0.001) 3. After 21 days antibiotic treatment , the concentration of excitatory amino acids were decreased significantly in 24 patients. However, in 8 patients the levels remained higher and their clinical outcomes were significantly worse than those of lower levels in the second CSF analysis(x2=6.095, P<0.05). The concentration of glutamate and aspartate of those who had poor clinical outcome three months since they were discharged from hospital did not decreased the normal levels. 4.The CSF levels of excitatory amino acid were negatively correlated with the concentrations of CSF glucose and positively correlated with the concentrations of protein in CSF.Conclusions 1. The changing of EAA in CSF in children with bacterial meningitis indicates that they may participate in pathophysiological mechanisms of BM. 2.Testing the levels of EAA will contribute to the judgment of the severity of cerebral injury of BM.3. A prolonged increase of EAA levels in the CSF may predict poor clinical outcome in patients with BM.Our findings showed that the concentrations of EAA in CSF are sensitive and reliable biochemical markers for evaluating the extent of brain damage of patients with bacterial meningitis and testing EAA concentration provided helpful clinical study data to us for the clinical use of the inhibitor of EAA receptor.更多还原