可溶性髓样细胞触发受体1、乳酸在细菌性脑膜炎患儿中的变化

Changes of soluble triggering receptor expressed on myeloid cells-1 and lactate in children with purulent meningitis

目的探讨脑脊液中可溶性髓样细胞触发受体1（STREM-1）、乳酸在小儿细菌性脑膜炎鉴别诊断中的价值及其在细菌性脑膜炎治疗前后的变化。方法采用干化学法及ELISA法分别测定24例细菌性脑膜炎、27例病毒性脑膜炎、25例脑脊液正常及22例细菌性脑膜炎患儿治疗后脑脊液中乳酸及STREM-1水平。结果1．细菌性脑膜炎组脑脊液STREM-1、乳酸水平均高于病毒性脑膜炎组及脑脊液正常组，差异均有统计学意义（P均〈0．05）；2．细菌性脑膜炎组治疗前脑脊液STREM-1及乳酸水平均高于治疗后组，差异均有统计学意义（P均〈0．05）；3．STREM-1受试者工作特征（ROC）曲线下面积（AUC）为0．891，乳酸AUC为0．940；脑脊液STREM-1水平为27．86ng／L的灵敏度为80．8％，特异度为75．0％；脑脊液乳酸水平为1．75mmol／L的灵敏度为90．4％，特异度为83．3％。结论1．脑脊液STREM-1、乳酸水平均与细菌性感染有关，其在细菌性脑膜炎诊断及鉴别诊断中具有一定价值。2．脑脊液STREM-1、乳酸水平在经有效抗生素治疗后细菌性脑膜炎的诊断及鉴别诊断中意义可能不大。3．脑脊液STREM-1、乳酸水平的下降提示感染的有效控制。

Objective To discuss the diagnosis significance of soluble triggering receptor expressed on mye-loid cells-1 （ STREM-1 ） and lactate in children with purulent meningitis, and to investigate the changes of STREM-1, lactate in cerebrospinal fluid （CSF） of purulent meningitis before and after treatment. Methods Dry chemical method and enzyme linked immunosorbent assay（ELISA） were used to measure STREM-1 and lactate levels in CSF of purulent meningitis group（24 cases）, viral meningitis group （ 27 cases）, CSF normal group （ 25 cases） and purulent meningitis after treatment group（22 cases）. Results 1. STREM-1 and lactate levels in CSF were higher in patients with purulent meningitis than in those with viral meningitis and CSF normal group（ all P 〈 0.05 ）. 2. STREM-1 and lactate levels in CSF were higher in patients with purulent meningitis before treatment than those after treatment（ all P 〈 0.05 ）. 3. The area under the curve（AUC） of STREM-1 in CSF was 0. 891, and at a cutoff level of 27.86 ng/L STREM-1 yielded a sensitivity of 80.8% and specificity of 75.0% ;the AUC of CSF lactate was 0. 940,and at a cutoff level of 1.75 mmol/ L lactate yielded a sensitivity of 90.4% and specificity of 83.3%. Conclusions 1. STREM-1 and lactate were asso-ciated with bacterial infection, they have considerable diagnostic values in purulent meningitis. 2. STREM-1 and lactate maybe worthless in differential diagnosis of purulent meningitis when treated by effective antibiotics. 3. The decline of STREM-1 and lactate in CSF prompts the control of infection and good prognosis.