신생아에서 뇌척수액 백혈구 증가증(CSF Pleocytosis)의 임상적 예측 인자
Clinical Predictors of Cerebrospinal Fluid Pleocytosis in Neonates - Clinical Predictors of CSF Pleocytosis in Neonates -
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목적: 신생아에서는 중증 감염이 의심되는 경우 일반적으로 시행하는 혈액, 소변검사들과 함께 LP도 높은 빈도로 시행하게 된다. 이는 신생아에서 뇌수막염의 원인과 관계없이 불량한 예후를 보이기때문이다. 저자들은 신생아에서 임상증상과 기본적인 검사를 통해서 CSF 백혈구 증가증을 예측하고, 이를 통해 세균성 감염과의 연관성을 찾아보고자 하였다. 방법: 2006년 1월부터 2011년 12월까지의 의무기록지를 후향적으로 조사해서 생후 30일 이하의 신생아 113명에서 CSF 백혈구 증가증의 예측 인자를 분석하기 위해 단변량 분석과 로지스틱 회귀분석을 시행하였다. 20명은 CSF 백혈구 증가증 군이었고 93명은 대조군이었다. 결과: 발열은 CSF 백혈구 증가증 군에서 85.0%로 대조군의52.7%에 비해 통계적으로 유의한 차이를 보였다(P=0.008, OR=5.08,95% CI, 1.39-18.54). 기면도 두 군간 유의했으며 특히 발열과 기면이각각 단독으로 있었던 경우와 비교해서 둘 다 있었던 환자가 CSF 백혈구 증가증과 유의한 관계를 보였다. 혈액검사 소견에서BUN은CSF 백혈구 증가증 군이 대조군보다 유의하게 높았다. 로지스틱 회귀분석에서 발열과 기면은 두 군 간 유의한 차이를 보였지만 BUN은 아니었다. CSF 백혈구 증가증이 있었던 환자 중 45%가 세균성 감염(뇌수막염, 요로감염)과 연관이 있었고 대조군과 비교했을 때 유의하게 높았다. 결론: 신생아에서 발열이나 기면 또는 두 증상이 동반하여 출현시 CSF 백혈구 증가를 예측하는데 도움이 될 것으로 보인다.
Abstract
Purpose: Young infants with suspected sepsis routinely undergo laboratory evaluation. In particular, when an infant is a newborn baby, evaluation of the cerebrospinal fluid (CSF) has been frequently included, because the prognosis is poor, irrespectively of the etiology of meningitis. We aimed to examine the clinical predictors of CSF pleocytosis among the newborns. Methods: We retrospectively reviewed the records of all infants, aged 30 days or younger, requiring lumbar puncture. Electronic data sources provided the demographic data of the newborns, the clinical manifestations, and all laboratory values. After a univariate analysis, logistic regression analysis was performed to predict newborns at increased risk for CSF pleocytosis. Results: One hundred thirteen newborns were studied; 20 of whom (17.7%) had CSF pleocytosis. Fever was significantly associated with CSF pleocytosis (P=0.008, OR=5.08, 95% CI, 1.39-18.54). The infants with lethargic appearance also had an increased risk for CSF pleocytosis. Blood urea nitrogen level was higher in patients with pleocytosis. Logistic regression analysis revealed that other clinical features and laboratory data were not significant, except for fever and lethargy. A total of 45% of the infants with CSF pleocytosis were diagnosed with serious bacterial infection, as opposed to 19.4% of those without CSF pleocytosis. Conclusion: In case of neonates, it would be better to perform lumbar puncture, when the infant has fever or lethargic appearance,although, the results of routine laboratory tests were nonspecific.
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