We measured concentration of some proteins such as interleukin-6 (IL-6), albumin (Alb), CRP and α
2 macroglobulin (α
2M) in both cerebrospinal fluid (CSF) and serum of patients with meningitis in order to evaluate the damage of blood-cerebrospinal fluid barrier (BCB). The permeability of the barrier was large for small molecular protein as in the order of Alb, CRP and α
2M. CRP level in CSF was proportional to CRP level in serum. Extremely high α
2M level in CSF was found only in patients whose barriers were damaged. α
2M level in CSF was well correlated to the ratio of (large protein)/(small protein) determined by HPLC, to the α
2M index ([α
2M]
CSF/[α
2M]
serum)/([Alb]
CSF/[Alb]
serum), and to cell counts in CSF. CRP concetration in CSF in bacterial meningitis (average 74.7μg/dl) was much higher than in viral meningitis (4.1μg/dl). However, CRP in CSF increased also in bacterial infection without meningitis (45.3μg/dl). Therefore, the determination of CRP and α
2M in CSF will be useful for differential diagnosis among bacterial meningitis, bacterial infection without meningitis and viral meningitis. IL-6 in CSF increased in acute phase of meningitis, and reflected the activity of meningitis.
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