Çocuklarda akut bakteriyel menenjit tanısında beyin-omirilik sıvısında tümör nekrozis faktör-alfa ve interlökin-6 düzeylerinin ölçümünün önemi

The importance of measuring cerebrospinal fluid tumor necrosis factor-alpha and interleukin-6 for the diagnosis of acute bacterial meningitis in children

Özet

Bu çalışmada yirmisi akut bakteriyel, yirmisi viral menenjit olan toplam kırk menenjitli çocuk ve kontrol grubundaki yirmi çocukta beyin omurilik sıvısı (BOS) örneklerinde tümör nekrozis faktör-alfa (TNF-$alpha$) ve interlökin-6 (IL-6) düzeyleri kompetetif enzim "immunoassay" ile ölçüldü. TNF-$alpha$ ve IL-6'nın BOS düzeylerinin hastanın yaşı ve tanı öncesi semptom süresi, BOS enflamasyon parametreleri (hücre sayısı ve tipi, protein, glukoz düzeyi,BOS/kan glukoz oranı), etken, kan enflamasyon parametreleri (periferik lökosit sayısı,eritrosit sedimentasyon hızı, kantitatif CRP), ateş, meningial semptomların düzelme süresi, komplikasyon ve sekeller ile ilişkisi, akut bakteriyel menenjit tanısı ve bakteriyel viral menenjitin ayırt edilmesindeki değeri ile rutin uygulamadaki yeri araştırıldı. BOS'da TNF-$alpha$ akut bakteriyel menenjitli hastaların %90'ında saptandı, buna karşın viral menenjitlilerde ölçüm sınırının altında bulundu. Bakteriyel menenjitli hastaların %85'inin, viral menenjitli hastaların %20'sinin BOS'unda IL-6 saptandı (p

Abstract

This study was undertaken to measure the levels of tumor necrosis factor-alpha (TNF-$alpha$) and interleukin-6 (IL-6) in cerebrospinal fluid (CSF) samples from 20 children with acute bacterial meningitis and 20 children with viral meningitis and in 20 control individuals by competitive enzyme immunoassay. The following parameters were investigated in relation to TNF-$alpha$ and IL-6 levels: age of the patient and duration of symptoms prior to diagnosis, CSF inflammation parameters (cell count and type, protein and glucose levels, CSF/ blood glucose ratio), causative agents, blood inflammation parameters (peripheral leukocyte count, erythrocyte sedimentation rate, quantitative C-reactive protein), fever, recovery from meningeal symptoms, complications and sequelae, diagnosis of acute bacterial meningitis, differential diagnosis of viral and bacterial meningitis, and value in routine application. In acute bacterial meningitis, TNF-$alpha$ was determined in 90 percent of the patients; however, in viral meningitis it was under detection level. IL-6 was determined in 85 percent of bacterial meningitis patients and in 20 percent of viral meningitis cases, Both were below detection level in the control group. In bacterial meningitis, diagnosis sensitivity of TNF-$alpha$ in CSF was 90 percent and specificity was 100 percent whereas for IL-6 the values were 80 and 100 percent, respectively. In differential diagnosis of viral and bacterial meningitis, sensitivity of TNF-$alpha$ was 90 percent and of IL-6 80 percent. There was no relation between age, agent, febrile days, recovery from meningeal symptoms, frequency of complications and CSF TNF-$alpha$ and IL-6 levels. In bacterial meningitis, CSF TNF-$alpha$ level, CSF cell count and polymorphonuclear leukocyte number and CSF/blood glucose ratio were related. However, only the peripheral leukocyte number was found to be related to CSF IL-6 level. Between CSF TNF-$alpha$ and CSF IL-6 levels, a very important relationship was observed. In bacterial meningitis both cytokines were found to be increased. In summary, in bacterial meningitis diagnosis and differential diagnosis of bacterial and viral meningitis, TNF-$alpha$ levels were more sensitive than IL-6, and measurement in CSF of this cytokine for routine analysis seems to be sufficient.