Журнал «Здоровье ребенка» 4 (47) 2013

Introduction. The bacterial meningitis - the heaviest and widespread infectious pathology of the central excitatory system (CNS) and, despite use enough effective antibacterial therapy, remains fatal at 5-25 % of patients and invokes neurologic complications in 30 % of patients [4].

As it is known, consciousness infringement is frequent enough symptom which is observed at purulent meningitis [8]. The biochemical basis of infringement of consciousness at various states can base on exchange infringement neurotransmitters amino acids (glutamate/GABA) and monoamines (dopamine/noradrenalin and a serotonin) [6].

Neurotransmitters are materials which provide nervous impulse transfer. Amino acid glutamate is the most widespread excitation neurotransmitter CNS [9]. In the sharp season of cerebral accident the augmentation of production of the majority of mediators is observed. Excessive allocation excitation neurotransmitterny amino acid of a glutamate is the most dangerous. This neurotransmitter is responsible for over excitation of the amazed neurons that defines development excitotoxicity or neurotoxicity. Glutamate excessively provokes N-Methyl-D-Aspartate receptor that leads to not supervised to an orifice of ions of calcium in neurons, activating processes of peroxide oxidation of lipids, processes of a proteolysis and apoptosis [1, 12].

Research objective - to define dependence of infringement of consciousness at children of patients on a purulent meningitis from concentration excitotoxic amino acids in blood.

Materials and methods. Research of samples of blood of 33 children with purulent meningitis which were treated in Khmelnitsky infectious hospital with 2010 for 2012 and 30 healthy children at the age from 1 month till 18 years is conducted. Definition in blood whey in 1 day after hospitalization excitotoxic amino acids glutamate (Glu) and aspartate (Аsp) was made by a method ion exchange liquid-column a chromatography at institute of biochemistry named by O.V.Paladin NАN Ukraine (Kiev). Degree of infringement of consciousness defined by means of a children's scale of comas of Glasgow (SCG). Processing of results was made by means of criterion of Student's and construction of 95 % of a confidence interval (CI) for a difference of averages, and also methods of the correlation and regressive analysis with construction of CI for a correlation coefficient.

Results. Consciousness infringement was observed at 11 (33,3 %) patients from whom at 3 (27,3 %) were defined devocalization, at 7 (63,6 %) sopor and at 1 (9,1 %) a coma. On SCG sick children with consciousness infringement were distributed as follows: 14 balls - at 2 patients, 12 balls - at 2 patients, 11 - balls at 2 patients, 10 balls - at 2 patients, 9 balls - at 2 patients and 8 balls - at 1 patient.

Concentrations of Glu and Asp at patients with consciousness infringement authentically were big in comparison with patients without consciousness infringement. At children with infringement of consciousness concentration of Glu compounded 318,3±139,0 mkmol/l, and at children without consciousness infringement - 140,5±48,1 mkmol/l, accordingly р <0,001 (95 % of CI, 111,2 - 244,2 mkmol/l). At children with infringement of consciousness concentration of Asp compounded 84,4±20,2 mkmol/l, and at children without consciousness infringement - 48,8±18,0 mkmol/l, accordingly р <0,001 (95 % of CI, 21,3 - 49,6 mkmol/l).

At healthy children concentration of Glu compounded 68,5±21,1 mkmol/l and was authentically smaller than at sick children with consciousness infringement (95 % of Dee, 156,6 - 342,9 mkmol/l) (р <0,001) and without consciousness infringement (95 % of CI, 37,4 - 106,5 mkmol/l) (р <0,001). At healthy children concentration of Asp compounded 15,6±8,2 mkmol/l and was also authentically smaller than at sick children with consciousness infringement (95 % of CI, 54,4 - 83,1 mkmol/l) (р <0,001) and without consciousness infringement (95 % of CI, 20,2 - 46,2 mkmol/l) (р <0,001).

For interrelation definition between concentration of exciting amino acids and degree of infringement of consciousness defined on SCG, it has been used correlation and regressive analyses.

The analysis has shown certain features of interrelation between Glu and consciousness level. The calculated coefficient of determination R²=0,603 testifies that in 60,3 % of cases change of concentration of Glu leads to changes of level of consciousness on SCG. The calculated correlation coefficient compounds r_calc =-0,77 where r_crit at n-2 = 0,60, id est r_crit <r_calc that is statistically significant (р <0,05) (95 % of CI for r, from -1,09 to -0,44). The gained data with use of criterion of Student's [t_calc=4,68 (t_crit for α =0,05 % compound 2,26), accordingly r_crit <t_calc], also testifies to the importance of a correlation coefficient. Thus, reverse and strong correlation communication between level of Glu and consciousness level on SCG, id est is defined at augmentation of concentration of Glu, consciousness level drops and testifies to significant influence of Glu on development of infringement of consciousness at children of patients on purulent meningitis.

The analysis has shown certain features of interrelation between Asp and consciousness level. In 60,1 % of cases change of concentration of Asp leads to change of level of consciousness to what the coefficient of determination R²=0,601 testifies. The calculated correlation coefficient compounds r_calc =-0,77 where r_crit at n-2 = 0,60, id est r_crit < r_calc that is statistically significant (р <0,05) (95 % of CI for r, from -1,09 to -0,44). The gained data with use of criterion of Student's [t_calc=4,68 (t_crit for α =0,05 % compound 2,26), accordingly r_crit <t_calc], also testifies to the importance of a correlation coefficient. Thus, reverse and strong correlation communication between level of Glu and consciousness level on SCG, id est is defined at augmentation of concentration of Glu, consciousness level drops and testifies to significant influence of Glu on development of infringement of consciousness at children of patients on purulent meningitis.

Thus, and Glu and Asp have almost identical influence on degree of infringement of consciousness and, is not excluded, strengthen action each other. Correlation analysis with use of Spearman rank correlation coefficient has defined authentic direct high correlation communication between concentration of Glu and Asp where r_calc=0,86 (r_crit =0,60), id est r_крит <r_calc that is statistically significant (р <0,05) (95 % of CI for r, from 0,72 to 1,0), id est, at augmentation of concentration of Glu also increase concentration of Asp in blood whey that testifies to significant interference of these neurotransmitters and, is not excluded, mutually strengthening influence on degree of infringement of consciousness at sick children on purulent meningitis.

Сonclusion. At augmentation of concentration glutamate and aspartate to blood whey, level of consciousness at children with purulent meningitis on SCG drops, to what reverse and authentically strong correlation communications where in both cases the correlation coefficient r compounds -0,77 (р <0,05) testify.

At augmentation of concentration of Glu concentration of Asp in blood whey that testifies to significant interference of these neurotransmitters also increases and, is not excluded, mutually strengthening influence on degree of infringement of consciousness at sick children on purulent meningitis to what authentic direct correlation communication between concentration of Glu and Asp, where a correlation coefficient r=0,86 (р <0,05) testifies.

High levels of Glu and Asp lead significant influence on development of infringement of consciousness at patients with purulent meningitis, therefore blocking of their action with use of antagonists of NMDA-receptors can promote restoration of consciousness at patients and improve disease passing.