정상아 및 소아 뇌막염환자의 뇌척수액당량과 혈당량과의 관계에 관한 연구

Abstract

[한글]

STUDY OF THE RELATIONSHIP BETWEEN GLUCOSE LEVEL IN CEREBROSPINAL FLUID AND IN BLOOD

OF NORMAL CHILDREN AND PATIENTS WITH MENINGITIS

Jae Seung Lee

Department of Medical Science, The Graduate School Yonsei University

(Directed by Prof. Duk Jin Yun)

Meningitis, despite the development of effective antibiotics, is still a disease

of high mortality and morbidity in pediatrics (Light, 1967). It is a disease

attracting a great deal of attention by pediatricians.

Sometimes meningitis in childhood shows atypical clinical symptoms and signs. The

occurrence of bacterial meningitis in the neonatal period and infants creates

special problems in early diagnosis, because the signs of meningeal irritation are

often minimal or nonexistent (Weliman, 1967).

Examination of the spinal fluid is the only method for immediate confirmation of

the diagnosis of meningitis. One of the most characteristic abnormalities of

cerebrospinal fluid in patients with bacterial and tuberculous meningitis is a

decrease in glucose content (Menkes, 1969).

Even though the reading of the cerebrospinal fluid may be abnormal (i.e. below

40mg%) no definite diagnosis can bemade by this examination alone. Futhermore in

general practice the clinical symptoms and laboratory data are often obscured

because of the indiscriminate use or poor administration of antibiotics.

Studies were carried out on 58 meningitis patients and 33 normal or

non-meningitis patients as control whose age ranged from birth to 15 years old

divided into 4 experimental groups as follows:

Group Ⅰ. normal or non-meningitis patients………… 33 cases

Group Ⅱ. purulent meningitis patients…………………20 cases

Group Ⅲ. tuberculous meningitis patients…………… 30 cases

Group Ⅳ. aseptic meningitis patients……………………8 cases

Spinal tapping was performed before treatment in all patients. The glucose

concentration was measured by Nelson-Somogyi micromethod (Nelson, 1944, somogyi,

1945).

The following results were obtained:

1. Blood glucose concentration in all experimental groups was around 86 mg%..

2. Glucose concentration of cerebrospinal fluid was normal in group Ⅳ as

compared to 55.73±2.23 mg% in group Ⅰ but was significantly decreased to

18.28±2.00 and 24.61±2.03 mg% in group Ⅱ and group Ⅲ, respectively.

3. In group Ⅰ glucose concentration of cerebrospinal fluid and blood was closely

related (r=0.755) but in group Ⅱ, Ⅲ and Ⅳ the relationship was markedly

dissociated.

4. The ratio of glucose concentration of cerebrospinal fluid to that of blood was

0.65±0.01 in group Ⅰ, 0.22±0.02 in group Ⅱ, 0.28±0.01 in group Ⅲ and

0.64±0.02 in group Ⅳ.

On the basis of the above results it may be concluded that the glucose

concentration of cerebrospinal fluid in meningitis is a good index of diagnosis and

the relationship between blood and cerebrospinal fluid glucose concentration can be

a helpful index for its diagnosis as well.

[영문]

Meningitis, despite the development of effective antibiotics, is still a disease of high mortality and morbidity in pediatrics (Light, 1967). It is a disease attracting a great deal of attention by pediatricians.

Sometimes meningitis in childhood shows atypical clinical symptoms and signs. The occurrence of bacterial meningitis in the neonatal period and infants creates special problems in early diagnosis, because the signs of meningeal irritation are often minimal or nonexistent (Weliman, 1967).

Examination of the spinal fluid is the only method for immediate confirmation of the diagnosis of meningitis. One of the most characteristic abnormalities of cerebrospinal fluid in patients with bacterial and tuberculous meningitis is a decrease in glucose content (Menkes, 1969).

Even though the reading of the cerebrospinal fluid may be abnormal (i.e. below 40mg%) no definite diagnosis can bemade by this examination alone. Futhermore in general practice the clinical symptoms and laboratory data are often obscured

because of the indiscriminate use or poor administration of antibiotics.

Studies were carried out on 58 meningitis patients and 33 normal or non-meningitis patients as control whose age ranged from birth to 15 years old divided into 4 experimental groups as follows:

Group Ⅰ. normal or non-meningitis patients………… 33 cases

Group Ⅱ. purulent meningitis patients…………………20 cases

Group Ⅲ. tuberculous meningitis patients…………… 30 cases

Group Ⅳ. aseptic meningitis patients……………………8 cases

Spinal tapping was performed before treatment in all patients. The glucose concentration was measured by Nelson-Somogyi micromethod (Nelson, 1944, somogyi, 1945).

The following results were obtained:

1. Blood glucose concentration in all experimental groups was around 86 mg%..

2. Glucose concentration of cerebrospinal fluid was normal in group Ⅳ as compared to 55.73±2.23 mg% in group Ⅰ but was significantly decreased to 18.28±2.00 and 24.61±2.03 mg% in group Ⅱ and group Ⅲ, respectively.

3. In group Ⅰ glucose concentration of cerebrospinal fluid and blood was closely related (r=0.755) but in group Ⅱ, Ⅲ and Ⅳ the relationship was markedly dissociated.

4. The ratio of glucose concentration of cerebrospinal fluid to that of blood was 0.65±0.01 in group Ⅰ, 0.22±0.02 in group Ⅱ, 0.28±0.01 in group Ⅲ and 0.64±0.02 in group Ⅳ.

On the basis of the above results it may be concluded that the glucose concentration of cerebrospinal fluid in meningitis is a good index of diagnosis and the relationship between blood and cerebrospinal fluid glucose concentration can be a helpful index for its diagnosis as well.