病毒性脑炎患儿血清和脑脊液VCAM-1、TNF-α变化及其意义

Clinical significance of serum and cerebrospinal fluid level changes of VCAM-1 and TNF-α in children with viral encephalitis

目的探讨血管细胞黏附分子-1(VCAM-1)与肿瘤坏死因子-α(TNF-α)在病毒性脑炎发病中的意义。方法采用双抗体夹心酶联免疫吸附法(ELISA)分别测定68例病毒性脑炎患儿急性期和恢复期血清及脑脊液VCAM-1、TNF-α水平,对照组为15例先天性畸形需外科手术患儿。结果病毒性脑炎患儿急性期血清、脑脊液VCAM-1和TNF-α分别为(15.68±2.90)μg/L、(17.18±3.67)μg/L和(2.09±0.45)μg/L、(2.25±0.54)μg/L,均高于对照组的(4.48±1.28)μg/L、(4.17±1.12)μg/L和(0.78±0.57)μg/L、(0.79±0.38)μg/L,差异有统计学意义(t=9.76～14.38,P均<0.01);恢复期病毒性脑炎患儿血清、脑脊液VCAM-1和TNF-α水平分别为(7.54±1.06)μg/L、(7.72±1.22)μg/L和(0.87±0.41)μg/L、(0.96±0.35)μg/L,与急性期比较差异有统计学意义(t=16.43～22.21,P均<0.01);脑脊液VCAM-1、TNF-α水平与血清VCAM-1、TNF-α水平呈显著正相关(r=0.728、0.716,P均<0.01),病毒性脑炎组血清及脑脊液VCAM-1与TNF-α也成显著正相关(r=0.747、0.729,P均<0.01)。结论 VCAM-1、TNF-α可能参与病毒性脑炎发病的病理过程,血清及脑脊液中VCAM-1、TNF-α水平检测对儿童病毒性脑炎的诊断有一定临床意义。

Objective To investigate the role of serum and cerebrospinal fluid changes of vascular cell adhesion molecule-1（VCAM-1）and tumor necrosis factor-α（TNF-α）in children with viral encephalitis.Methods Sixty-eight children with viral encephalitis（object group）,as well as age-matched fifteen patients undergone operation for congenital malformations（control group）were studied.The levels of serum and cerebrospinal fluid VCAM-1,TNF-α during the acute and convalescent phases were determined by enzyme-linked immunosorbent assay.Results Serum and cerebrospinal fluid VCAM-1,TNF-α levels of subject group in acute phase[（15.68 ± 2.90）μg/L,（17.18 ± 3.67）μg/L,（2.09 ± 0.45）μg/L and（2.25 ± 0.54）μg/L]were significantly higher（P〈0.01）than those of control group[（4.48 ± 1.28）μg/L,（4.17 ± 1.12）μg/L,（0.78 ± 0.57）μg/L and（0.79 ± 0.38）μg/L].The levels of serum and cerebrospinal fluid VCAM-1,TNF-α decreased significantly（P〈0.01）in the convalescent phase[（7.54 ± 1.06）μg/L,（7.72 ± 1.22）μg/L,（0.87 ± 0.41）μg/L and（0.96 ± 0.35）μg/L,respectively;]compared with those in acute phase.Cerebrospinal fluid level of VCAM-1 and TNF-α were positively correlated with serum VCAM-1 and TNF-α（r = 0.728,0.716,P〈0.01）.Furthermore,serum and cerebrospinal fluid level of VCAM-1,TNF-α in subject group also had a significant positive correlation（r = 0.747,0.729,P〈0.01）.Conclusions The increase of the serum and cerebrospinal fluid VCAM-1,TNF-α concentrations in children with viral encephalitis suggest that VCAM-1 and TNF-α may play a role in pathogenesis of viral encephalitis,and the measurement of VCAM-1,TNF-α levels in serum and cerebrospinal fluid was valuable for diagnosis in childhood viral encephalitis.