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Clinical Analysis of Children Purulent Meningitis and Pathogenesis Preliminary Study

Author: YangZuo
Tutor: YinFei
School: Central South University
Course: Clinical
Keywords: Purulent meningitis tumor necrosis factor-alpha blood-brain barrier Bnd.3cells BMECs permeability
CLC: R725.1
Type: Master's thesis
Year: 2013
Downloads: 32
Quote: 0
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Abstract


Background and objectives:Purulent meningitis is more common in children during nervous system infection, before antibiotics used in clinical, the disease is most lethal. With the clinical application of antibiotics combined therapy measures, the prognosis of purulent meningitis has greatly changed, but still have a higher mortality rate, the neurological sequelaes are very common.Early diagnosis and appropriate intervention is the key to reducing mortality and sequelae of the disease incidence.Stimulation of meningococcal disease and vasculitis can cause brain parenchymal edema, necrosis, prompting the release of cytokines and increased capillary permeability, coupled with a wide range of inflammatory lesions of cerebrospinal fluid circulation disorder occurs, these factors can cause cerebral edema and cranial pressure, severe brain herniationPurulent meningitis essence of a strong inflammatory response, in purulent meningitis inflammatory process, inflammatory cells release a large number of cytokines, like TNF-a,which can be further exacerbated inflammatory response, cytokine-mediated inflammatory response in the cerebrospinal fluid clear still continue to exist, which may be one of the reasons of the brain chronic inflammatory sequelae. So how is TNF-α involved in the inflammatory process of purulent meningitis?The blood-brain barrier is a layer of continuous coverage of99%of the cavity surface of the brain capillary endothelial cells, has important significance for the stability of the environment within the central nervous system. Trauma, ischemia and hypoxia, infection, immunity and physical and chemical factors, etc. may cause tight junction structure and function change, cause BBB damages, resulting in increased BBB permeability caused by cerebral edema. The blood-brain barrier(BBB) permeability increase induced vasogenic brain edema in the incidence play a key role.It has been reported that pro-inflammatory tumor necrosis factor alpha(TNF-a) can cause increased permeability of the intestinal epithelial cells, and then, if it also can cause brain microvascular endothelial cell permeability increase?In this study, we analyze the clinical features of the purulent meningitis, and purulent meningitis in children with cerebrospinal fluid TNF-a changes, and then use of immortalized mouse bEnd.3cells brain microvascular endothelial cell barrier model, stimulated it with TNF-a then observed the impact of the blood-brain barrier permeability, study the pathogenesis of purulent meningitis preliminary.MethodsAnalysis the clinical data and diagnosis and treatment of30cases of children with purulent meningitis and the control group, then the TNF-a in the cerebrospinal fluid of all patients and the control group were determined, cultured the Bend.3cells to establish the BMECs model in vivo,and measure the TEER of Bend.3cells after stimulated by TNF-a.Resultsl.The selected30cases of children meet the diagnosis of purulent meningitis。2.Purulent meningitis in children with cerebrospinal fluid TNF-α significantly increased, and associated with complications.3.TNF-α cause to bEnd.3cells TEER reduced, and having a time dependent manner.Conclusion1. Purulent meningitis is an important CNS infectious diseases, easily lead to complications. Though antibiotics based integrated clinical treatment used, the incidence of complications rate is still high, the complication rate of this study is30%。2. TNF-a involved in the inflammatory cascade is one of the main reasons for complication in children with purulent meningitis.3. TNF-a can cause increased permeability of the blood-brain barrier, that may be the mechanism of activation involved in the purulent meningitis inflammatory response fall。

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