CAJ | 학술논문

目的建立细菌性脑膜炎动物模型,了解细菌感染后48 h内脑脊液(CSF)细菌载量变化规律,为疾病的诊疗及预后判断提供参考依据.方法以新西兰大白兔作为研究对象,通过小脑延髓池穿刺建立细菌性脑膜炎动物模型,观察不同菌量的大肠埃希菌和金黄色葡萄球菌(金葡菌)建立模型时动物的死亡情况.明确CSF感染菌量与动物死亡率间的对应关系.选择合适的接种菌量,进行脑膜炎CSF细菌载量观察实验.将实验动物分为4组(每组12只):大肠埃希菌脑膜炎模型组,大肠埃希菌脑膜炎+头孢曲松治疗组、金葡菌脑膜炎模型组、金葡菌脑膜炎+万古霉素治疗组,在建立模型后0、12、24、36和48 h分别进行CSF细菌定量培养、CSF及外周血WBC计数,进而分析细菌性脑膜炎CSF细菌载量的变化规律,及其与动物早期死亡率、抗菌药物治疗、CSF的WBC计数间的关系.CSF细菌载量、WBC计数曲线的显著性检验采用协方差分析,相关性检验采用偏相关分析.结果 CSF感染菌量与动物死亡率间呈现S型曲线关系,CSF细菌载量在蛛网膜下腔接种细菌12～24 h达到高峰,而后逐步下降,有效的抗菌药物治疗可显著加快下降过程,大肠埃希菌脑膜炎模型组与大肠埃希菌脑膜炎+头孢曲松治疗组相比(F=27.10,P<0.01),金葡菌脑膜炎模型组与金葡菌脑膜炎+万古霉素治疗组相比(F＝5.97,P=0.016),差异均有统计学意义.大肠埃希菌脑膜炎模型组和金葡菌脑膜炎模型组中的CSF的WBC计数与CSF细菌载量之间存在正相关性(r＝0.89、0.84;P=0.046、0.049).结论在细菌性脑膜炎的治疗中,应早期,足量地使用有效抗生素,以控制CSF细菌载量,降低死亡率.CSF的WBC计数可作为反映CSF细菌载量的指标,指导临床治疗.
목적 건립세균성뇌막염동물모형,료해세균감염후48 h내뇌척액(CSF)세균재량변화규률,위질병적진료급예후판단제공삼고의거.방법 이신서란대백토작위연구대상,통과소뇌연수지천자건립세균성뇌막염동물모형,관찰불동균량적대장애희균화금황색포도구균(금포균)건립모형시동물적사망정황.명학CSF감염균량여동물사망솔간적대응관계.선택합괄적접충균량,진행뇌막염CSF세균재량관찰실험.장실험동물분위4조(매조12지):대장애희균뇌막염모형조,대장애희균뇌막염+두포곡송치료조、금포균뇌막염모형조、금포균뇌막염+만고매소치료조,재건립모형후0、12、24、36화48 h분별진행CSF세균정량배양、CSF급외주혈WBC계수,진이분석세균성뇌막염CSF세균재량적변화규률,급기여동물조기사망솔、항균약물치료、CSF적WBC계수간적관계.CSF세균재량、WBC계수곡선적현저성검험채용협방차분석,상관성검험채용편상관분석.결과 CSF감염균량여동물사망솔간정현S형곡선관계,CSF세균재량재주망막하강접충세균12～24 h체도고봉,이후축보하강,유효적항균약물치료가현저가쾌하강과정,대장애희균뇌막염모형조여대장애희균뇌막염+두포곡송치료조상비(F=27.10,P<0.01),금포균뇌막염모형조여금포균뇌막염+만고매소치료조상비(F＝5.97,P=0.016),차이균유통계학의의.대장애희균뇌막염모형조화금포균뇌막염모형조중적CSF적WBC계수여CSF세균재량지간존재정상관성(r＝0.89、0.84;P=0.046、0.049).결론 재세균성뇌막염적치료중,응조기,족량지사용유효항생소,이공제CSF세균재량,강저사망솔.CSF적WBC계수가작위반영CSF세균재량적지표,지도림상치료.
Objective To study the dynamics changes of cerebrospinal fluid (CSF) bacterial load within 48 h after infection in a rabbit meningitis model, and provide information for diagnosis,treatment and prognosis of this disease. Methods Taking New Zealand white rabbit as the study object, meningitis model was established via cerebellar cistern puncture with different concentrations of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) to explore the relationship between the mortality of animals and the subarachnoid inoculation dosage. The dynamics study of CSF bacterial load was conducted with proper inoculation bacterial dosage. Forty-eight rabbits were separated into four groups (12 each group): E. coli meningitis model group, E. coli meningitis + ceftriaxone treated group, S. aureus meningitis model group and S. aureus meningitis + vancomycin treated group. At 0,12, 24, 36 and 48 h of inoculation, CSF and blood samples were obtained for CSF bacterial quantitative culture, CSF leukocyte count and peripheral blood leukocyte count. Finally, the relationships between the early mortality of animals, the efficacy of antibiotics, CSF leukocyte counts and the dynamics changes of CSF bacterial load were analyzed in the bacterial meningitis rabbit model.The CSF bacterial load and the white blood cell count curve were compared by analysis of covariance (ANOVA). Correlation test was done using correlate partial analysis. Results The relationship between subarachnoid inoculation dosage and the mortality of rabbits presented S-curve correlation.The bacterial load in subarachnoid space peaked in 12-24 h after infection and then gradually decreased. Effective antibiotic therapy could significantly speed up the decline of this process. There were significantly different between E. coli meningitis model group and E. coli meningitis+ceftriaxone treated group (F= 27. 10, P<0. 01), between S. aureus meningitis model group and S. aureus meningitis + vancomycin treated group (F=5. 97, P = 0. 016). There was a positive correlation between CSF bacterial load and CSF leukocyte count in E. coli and S. aureus meningitis model groups (r=0. 89, 0.84, respectively; P = 0.046, 0.049, respectively). Conclusions In the treatment of bacterial meningitis, effective and sufficient antibiotics should be used as soon as possible to control the CSF bacterial load and reduce the mortality. The CSF leukocyte count can be used as indicator of CSF bacterial load and guide the antibiotic treatment in clinical bacterial meningitis.