Ayhan ŞEKER, Gülnur TOKUÇ, Ayça VİTRİNEL, Sedat ÖKTEM, Serdar CÖMERT

Menenjitli vakalarda beyin omirilik sıvısındaki enzimatik değişimler

Amaç: Bu çalışma püriilan, tüberküloz (tbc) ve aseptik menenjitleri erken dönemde ayırt etmek için kullanılabilecek biyokimyasal metotların saptaması ve bu metotların gelişebilecek komplikasyonlan öngörme açısından yararının belirlenmesi amacıyla planlandı. Yöntem: Çalışmamıza kliniğimizde tedavi gören 48 menenjit ve 25 kontrol vakası dahil edildi. Vakalara başvuru sırasında ve tedavinin 10. gününde olmak üzere 2 defa ponksiyon lomber uygulandı. Serum ve bejin omurilik sıvılarında (BOS) AST, ALT, LDH, GGT ve ALP düzey tayini yapıldı. Vakalar kontrol grubu, aseptik, bakteriyel ve tüberküloz (tbc) menenjit olarak 4 gruba ayrıldı. Bulgular: Vakaların 43'ü (% 58) erkek, 30'u (% 42) kız idi. Aseptik menenjitli 14 (% 29), bakteriyel, menenjitti 23 (% 48), tüberküloz menenjitli 11 (% 23) vaka vardı. Kontrol vakalarının beyin omurilik sıvısı emim değerleri her bir menenjit grubundaki vakalarla karşılaştırıldığında; aseptik menenjitte enzimler normal, bakteriye! menenjitte AST, LDH, GGT ve ALP anlamlı derecede yüksek, tüberküloz menenjitte ise ALT ve LDH anlamlı derecede yüksek bulundu. Bakteriyel menenjitli olup komplikasyon gelişen vakalarda BOS AST, LDH ve GGT değerleri anlamlı olarak yüksekti. Sonuç: BOS'daki enzimlerin menenjitlerin ayırıcı tanısında ve prognostik kriter olarak fikir verebileceği, ancak bu konuda multifaktöriyel irdelemenin yararlı olacağı sonucuna varıldı.

Anahtar Kelimeler:

Tanı, ayırıcı, Çocuk, Beyin omurilik sıvısı, Menenjit, aseptik, Erken tanı, Tüberküloz, meningeal, Menenjit, bakteriyel

The enzymatic changes in cerebrospinal fluid in patients with meningitis

Aim: This study was planned to determine the appropriate biochemical methods for the differential diagnosis of purulant, tuberculous (tbc) and aseptic meningitis at the beginning of the illness and to investigate the usefulness of these methods to predict the complications that may be seen during these illnesses. Material and Methods: In this study, there were 48 meningitis and 25 control cases. Lomber punction (LP) was performed at the beginning and on the 10th day of the treatment. The levels of AST, ALT, LDH, GGT, ALP in cerebrospinal fluid (CSF) and serum were measured. The cases were divided into four groups as controls, aseptic, bacterial and tbc meningitis. Results: 43 (58 %) of the cases were male; 30 (42 %) were female. There were 14 (29 %) aseptic; 23 (48 %) bacterial; 11 (23 %) tbc meningitis cases. When the CSF enzyme levels of the control group were compared to each group of meningitis, the enzymes were normal in aseptic meningitis, AST, LDH, GGT and ALP were found to he significantly higher in bacterial meningitis and ALT and LDH were also significantly higher in tbc meningitis. Also it was found that CSF AST, LDH and GGT were significantly higher in cases who developed complications compared to the cases without complications in the bacterial meningitis group. Conclusion: CSF enzymes can be used for the differential diagnosis of meningitis and as prognostic markers but multifactorial analysis including more patients will be more reliable.

Keywords:

Diagnosis, Differential, Child, Cerebrospinal Fluid, Meningitis, Aseptic, Early Diagnosis, Tuberculosis, Meningeal, Meningitis, Bacterial,

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