病毒性脑炎患儿脑脊液中VEGF VCAM-1变化及其意义

Changes and roles of VEGF and VCAM-1 in cerebrospinal fluid of children with viral encephalitis

目的病毒性脑炎(VE)是脑实质广泛受损的病变,具有较高的病死率和后遗症发生率。VE发病机制的一个重要部分即是血管内皮细胞的损伤。该研究通过测定VE患儿脑脊液中血管内皮细胞生长因子(VEGF)及血管细胞粘附分子-1(VCAM-1)水平的变化,探讨VEGF,VCAM-1在VE发病机制中的作用,以及其对VE病情严重性及预后评估的临床意义。方法应用双抗体夹心ELISA法检测65例VE患儿不同时期脑脊液中VEGF和VCAM-1的水平。结果VEGF,VCAM-1水平在VE急性期与恢复期明显高于对照组;急性期与恢复期相比,其差异具有统计学意义。VE重度组患儿脑脊液中VEGF,VCAM-1水平与轻度组相比不具有统计学差异。VE各组脑脊液中VEGF与VCAM-1水平均具有明显相关性。VE患儿脑脊液中蛋白含量越大,脑脊液中VEGF,VCAM-1水平越高,尤以蛋白含量在0.4g/L～1.0g/L明显,与蛋白含量<0.4g/L相比,差异具有统计学意义。VE患儿脑脊液中细胞数越多,脑脊液中VEGF,VCAM-1水平越高,但却不具有明显相关性。VE组患儿抽搐次数、EEG改变与脑脊液中VEGF,VCAM-1水平之间无统计学上的差异。但头MRI改变严重者,脑脊液中VEGF,VCAM-1水平增高明显,且差异有显著性。结论VEGF,VCAM-1可能参与VE的发病机制,对VE的病情严重性评估及预后判断有一定意义。

Objective Vascular endothelial cell injury contributes to the pathogenesis of viral encephalitis. This study was designed to investigate the roles of vascular endothelial growth factor （VEGF） and vascular cell adhesion molecule-1 （ VCAM-1 ） in cerebral spinal fluid （CSF） in the pathogenesis of viral encephalitis and in the evaluation of the severity and the prognosis of viral encephalitis in children. Methods CSF VEGF and VCAM-1 levels were measured using ELISA in 65 children with viral encephalitis and 20 age-matched controls （10 cases of epilepsy and 10 cases of congenital abnormality）. Results CSF levels of VEGF and VCAM-1 in the viral encephalitis group in the acute phase were significantly elevated compared with those in the congenital abnormality （P 〈 0.01 ） and the epilepsy groups （P 〈 0.05 ）. CSF levels of VEGF and VCAM-1 in the viral encephalitis group in the recovery phase decreased significantly and were similar to the levels of the epilepsy group, but remained higher than those in the congenital abnormality group （ P 〈 0.05 ）. There was a positive correlation between CSF levels of VEGF and VCAM-1 in the viral encephalitis group in the acute and recovery phases. CSF levels of VEGF and VCAM-1 were positively correlated to CSF protein contents and the degree of MRI abnormality in the viral encephalitis group. Conclusions VEGF and VCAM-1 may participate in the pathogenesis of viral encephalitis. Detection of the two parameters may be helpful to the evaluation of the severity and prognosis of viral encephalitis.