Níveis de proteína C reativa no soro e líquido cefaloraquidiano para o diagnóstico de meningite bacteriana neonatal
Authors: Hashimoto Elza Harumi Yonekura , Capobiango Jaqueline Dario , Carvalho Ana Berenice Ribeiro , Matsuo Tiemi , Reiche Edna Maria Vissoci 
Published: April 2018

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mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} --> <!--[endif] --> <p class="MsoNormal" style="margin-left: 2.85pt; text-align: justify;">Introdução: As alterações bioquímicas e celulares observadas no líquido cefaloraquidiano (LCR) no período neonatal exibem amplas variações, o que dificulta o diagnóstico de meningite bacteriana. Entre os marcadores laboratoriais de inflamação aguda, a proteína C reativa (PCR) pode ser utilizada no auxílio do diagnóstico de meningite. Objetivo: Determinar os níveis de PCR em amostras de soro e LCR de recém-nascidos (RNs) com diagnóstico de meningite neonatal. Metodologia: Foram avaliados 48 RNs com diagnóstico de meningite bacteriana e de 37 RNs com sepse tardia sem meningite associada atendidos na Unidade Neonatal do Hospital Universitário de Londrina, Paraná. A dosagem da PCR no soro foi realizada por imunoturbidimetria e no LCR por imunonefelometria ultra-sensível. Resultados: Os níveis de PCR entre os RNs com meningite bacteriana variaram de 0,4 a 170mg/L (média 35,1 ± 40,2 e mediana 22,5) no soro e de 0,0 a 10,8mg/L (média 1,1 ± 2,0 e mediana 0,5) no LCR. Em 27/38 (71,0%) pacientes com meningite bacteriana e em 14/29 (48,3%) com sepse tardia, houve elevação dos níveis de PCR no LCR</p><p class="MsoNormal" style="margin-left: 2.85pt; text-align: justify;">(p=0,0580). Porém, quando os valores de PCR no soro e no LCR foram categorizados (<3, 3-19, 20- 40 e >40mg/L para o soro e <0,175, 0,175- 4 e > 4 mg/L para o LCR), não houve diferença entre os dois grupos (p=0,1375 e p=0,1645, respectivamente). Conclusão: A elevação da PCR no LCR sugere a presença de meningite bacteriana; porém, a passagem da PCR sérica pela barreira hematoencefálica em RNs com meningite bacteriana e em RNs com sepse sem meningite limita a sua utilização como marcador laboratorial de diagnóstico de meningite neonatal.</p>