The Detection And Clinical Significance Of Cerebrospinal Fluid Lactate In Children With Central Nervous System Infection

Objective To observe the changes of cerebrospinal fluid(CSF)lactate(LA)and evaluate the value of it in children with various central nervous system infection diseases and provide a guide for clinical diagnosis and treatment.Methods 540 hospitalized children with the central nervous system infection diseases in the department of pediatrics of the 1st affiliated hospital of Fujian medical university from Jan 2010 to Dec 2017 were included as the patient groups,of which,87 of purulent meningitis and 453 of central nervous system virus infections.29 hospitalized children with the acute upper respiratory tract infection were included as control group.All subjects received lumbar puncture and the CSF were detected.CSF-LA content was measured by dry chemical colorimetry in both groups.The normal reference values of CSF-LA ranged from 0.7~2.1mmol/L and the upper limit of it as abnormal.SPSS 22.0 software was used for the statistical analysis and ?=0.05 as a significant test standard.Results The abnormal number(%)of CSF-LA content in purulent meningitis,central nervous system virus infections and the control group were 55(63.2%),27(6.0%),and 0(0%),the content of CSF-LA(M,IQR)were(2.57,1.90~3.51),(1.40,1.23~1.65),and(1.16,1.11~1.28)mmol/L,and CSF lactate/glucose(CSF-L/G)ratio were 1.32(0.95~1.79),0.49(0.42~0.60),and 0.42(0.39~0.47),respectively.CSF-LA content and CSF-L/G ratio in patient groups were higher significantly than in the control group(P<0.01);Compared with the central nervous system virus infection group,CSF-LA content and CSF-L/G ratio in the purulent meningitis were higher significantly(P<0.01).CSF-LA content were correlated with the CSF leucocyte counts or protein content positively(correlation coefficient were 0.565 and 0.364,respectively.P<0.01),and correlated with the CSF glucose or chloride content negatively(correlation coefficient were-0.295 and-0.256,respectively.P<0.01).Based on the clinical diagnosis at discharge as the demarcation criterion for various central nervous system infectious diseases,CSF-LA content and CSF-L/G ratio were evaluated for the values of diagnosis of purulent meningitis,and the area under the curve(AUC)(95% CI)were 0.883(0.837~0.929)and 0.953(0.933~0.973)(P<0.01).The sensitivity and specificity were 79.3% and 85.8% respectively when the threshold of CSF-LA content in 1.845 mmol/L,were 82.8% and 91.9% respectively when the cut-off point of CSF-L/G ratio in 0.8004.AUC of CSF-L/G ratio combined with CSF leukocyte counts and protein content was 0.987(0.980~0.995),is higher than the AUC of CSF-LA content or CSF-L/G ratio(P<0.01).Conclusions CSF-LA content and CSF-L/G ratio were significantly increased in children with central nervous system infectious diseases.While at a cut off value of CSF-LA content in 1.845 mmol/L and CSF-L/G ratio in 0.8004,they have high diagnostic accuracy for purulent meningitis with high sensitivity and specificity.CSF-L/G ratio combined with CSF leucocyte counts and protein content has good performance in sensitivity,specificity,is more helpful to the diagnosis of purulent meningitis in children.