颅内感染患者脑脊液和血清C反应蛋白和基质金属蛋白酶9水平的变化和意义

Changes and significance of C-reactive protein and matrix metalloproteinase-9 in cerebrospinal fluid and serum of patients with intracranial infection

目的 观察颅内感染患者脑脊液和血清C反应蛋白（CRP）和基质金属蛋白酶9（MMP-9）水平的变化,并探讨其临床意义.方法 分别应用乳胶增强免疫比浊法和酶联免疫吸附法检测43例颅内感染患者急性期和恢复期CRP、MMP-9水平,并与21例同期外科手术患者（对照组）进行比较.43例颅内感染患者分为病毒性脑膜脑炎（病脑）组24例、结核性脑膜炎（结脑）组12例、化脓性脑膜炎（化脑）组7例.结果 结脑组急性期脑脊液和血清CRP水平分别为（7.12±2.32）、（28.84±4.91）μg/L,化脑组分别为（8.68±2.32）、（32.60±6.94）μg/L,对照组分别为（3.20±1.62）、（9.96±3.45）μg/L,结脑组和化脑组急性期脑脊液和血清CRP水平显著高于对照组（P＜0.05）;病脑组急性期和恢复期、结脑组和化脑组恢复期脑脊液和血清CRP水平与对照组比较差异无统计学意义（P＞0.05）,结脑组和化脑组急性期与恢复期脑脊液和血清CRP水平比较差异也无统计学意义（P＞0.05）.病脑组、结脑组和化脑组急性期及恢复期脑脊液和血清MMP-9水平均显著增高,与对照组比较差异均有统计学意义（P＜0.05）,且三组恢复期MMP-9水平显著下降,与急性期比较差异有统计学意义（P＜0.05）;结脑组、化脑组急性期和恢复期脑脊液和血清MMP-9水平显著高于病脑组（P＜0.05）;化脑组与结脑组急性期和恢复期MMP-9水平比较差异无统计学意义（P＞0.05）.结论 脑脊液和血清CRP水平与病脑无明显关系,但在结脑和化脑急性期明显增高.MMP-9水平在三者颅内感染中均明显增高,特别是结脑和化脑患者增高更加明显,在恢复过程中逐渐下降.脑脊液和血清CRP、MMP-9水平的变化有助于判定颅内感染的阶段、性质、严重程度及预后情况.

Objective To evaluate the changes of C-reactive protein （CRP） and matrix metalloproteinase-9 （MMP-9） in cerebrospinal fluid and serum of patients with intracranial infection,in order to explore their significance.Methods The levels of CRP and MMP-9 in 43 cases patients with intracranial infection of the acute and recovery phase and 21 normal people （control group） were determined by immunohistochemical turbidimetric method and radioimmunity method.In 43 patients,24 cases of viral encephalitis （viral encephalitis group）,12 cases of tuberculous meningitis （tuberculous meningitis group） and 7 cases of purulent meningitis （purulent meningitis group）.Results The levels of CRP of cerebrospinal fluid and serum in the acute phase in tuberculous meningitis group [（7.12 ±2.32）,（28.84 ±4.91） μg/L] and purulent meningitis group [（8.68 ± 2.32）,（32.60 ± 6.94） μg/L] were significantly higher than those in control group [（3.20 ± 1.62）,（9.96 ± 3.45） μ g/L] （P 〈0.05）;the levels of CRP had no significantly statistical difference in the acute and recovery phase between viral encephalitis group and control group （P〉0.05）,and there was no significant difference in the levels of CRP of cerebrospinal fluid and serum in the recovery phase between tuberculous meningitis group or purulent meningitis group and control group （P〉0.05）.There was no significant difference in the levels of CRP in tuberculous meningitis group and purulent meningitis group between the acute phase and recovery phase （P〉0.05）.The levels of MMP-9 in the acute and recovery phase of all the groups were significantly higher than those in control group （P 〈0.05）.The levels of MMP-9 in the recovery phase of all the groups were significantly decreased,compared with those in the acute phase （P〈0.05）.Especially the levels of MMP-9 in the acute and recovery phase in tuberculous meningitis group and purulent meningitis group were significantly higher than those in viral encephalitis group （P〈0.05）.There were no significant difference in the levels of MMP-9 in tuberculous meningitis and purulent meningitis group between the acute phase and the recovery phase （P〉0.05）.Conclusions There is no significant relationship between CRP and viral encephalitis,however the levels of CRP are significantly increased in the acute phase of bacterial intracranial infections.The levels of MMP-9 in the three kinds of intracranial infection are signifcanfiy increased,especially in tuberculous meningitis and purulent meningitis patients,and they gradually decrease during the recovery procedure.The changes of CRP and MMP-9 would help to determine the phases,the kinds,the severity and the prognosis of intracranial infection.