血清及脑脊液S100蛋白和降钙素原诊断颅内感染的价值

Values of S100 protein and procalcitonin in serum and cerebrospinal fluid to the diagnosis of intracranial infection

目的探讨血清及脑脊液S100蛋白、降钙素原(procalcitonin,PCT)在颅内感染诊断中的应用价值。方法颅内感染患者91例,其中细菌性脑炎患者43例(细菌性脑炎组),病毒性脑炎患者48例(病毒性脑炎组);同期38例癫痫患者为对照组。采用ELISA法检测3组入院48h内血清及脑脊液S100蛋白水平,电化学发光免疫法检测血清及脑脊液PCT水平;绘制ROC曲线分析血清及脑脊液S100蛋白、PCT鉴别诊断细菌性脑炎、病毒性脑炎的效能。结果病毒性脑炎组、细菌性脑炎组血清S100蛋白[(21.24±8.32)、(50.91±11.55)μg/L]、脑脊液S100蛋白[(14.60±6.45)、(40.38±8.05)μg/L]水平高于对照组[(0.24±0.10)、(2.16±0.72)μg/L],血清PCT[(0.38±0.12)、(0.89±0.22)μg/L]、脑脊液PCT[(0.19±0.09)、(0.76±0.20)μg/L]水平高于对照组[(0.23±0.09)、(0.09±0.03)μg/L](P<0.05),且细菌性脑炎组高于病毒性脑炎组(P<0.05);血清、脑脊液S100分别以36.19、28.51μg/L为最佳截断值,鉴别诊断细菌性脑炎与病毒性脑炎的AUC分别为0.972(95%CI:0.942～1.000,P<0.001)、0.994(95%CI:0.981～1.000,P<0.001),灵敏度分别为90.7%、97.7%,特异度分别为95.8%、97.9%;血清、脑脊液PCT分别以0.56、0.46μg/L为最佳截断值,鉴别诊断细菌性脑炎与病毒性脑炎的AUC分别为0.968(95%CI:0.924～1.000,P<0.001)、0.998(95%CI:0.993～1.000,P<0.001),灵敏度分别为93.0%、97.7%,特异度分别为95.8%、97.9%。结论颅内感染患者血清及脑脊液S100蛋白、PCT水平均升高,检测血清及脑脊液S100蛋白、PCT水平有助于细菌性脑炎与病毒性脑炎的鉴别诊断。

Objective To investigate the applications of S100 protein and procalcitonin(PCT)in serum and cerebrospinal fluid in the diagnosis of intracranial infection.Methods Ninety-one patients with intracranial infection were divided into 43 patients with bacterial encephalitis(bacterial encephalitis group)and 48 patients with viral encephalitis(viral encephalitis group)while another 38 patients with epilepsy were as controls(control group).The levels of S100 protein and PCT in serum and cerebrospinal fluid were detected by ELISA and electrochemiluminescence immunoassay respectively,and ROC was drawn to analyze the efficacies of S100 protein and PCT in serum and cerebrospinal fluid on differentiating bacterial encephalitis from viral encephalitis.Results The levels of S100protein(serum:(21.24±8.32),(50.91±11.55)μg/L;cerebrospinal fluid:(14.60±6.45),(40.38±8.05)μg/L)and PCT(serum:(0.38±0.12),(0.89±0.22)μg/L;cerebrospinal fluid:(0.19±0.09),(0.76±0.20)μg/L)in viral encephalitis group and bacterial encephalitis group were significantly higher than those in control group(S100protein:(0.24±0.10),(2.16±0.72)μg/L;PCT:(0.23±0.09),(0.09±0.03)μg/L)(P<0.05),and higher in bacterial encephalitis group than those in viral encephalitis group(P<0.05).When the optimal cut-offvalues of S100 protein in serum and cerebrospinal fluid were 36.19 and 28.51μg/L,respectively,the AUCs for bacterial encephalitis and viral encephalitis were 0.972(95%CI:0.942-1.000,P<0.001)and 0.994(95%CI:0.981-1.000,P<0.001),the sensitivities were 90.7% and 97.7%,and the specificities were 95.8% and 97.9%,respectively;when the optimal cut-off values of PCT in serum and cerebrospinal fluid were 0.56 and 0.46μg/L,the AUCs for bacterial encephalitis and viral encephalitis were 0.968(95%CI:0.924-1.000,P<0.001)and 0.998(95%CI:0.993-1.000,P<0.001),the sensitivities were 93.0% and 97.7%,and the sensitivities were 95.8% and 97.9%,respectively.Conclusion The levels of S100 protein and PCT in serum and cerebrospinal fluid increase in patients with intracranial infection,and the detection of them contributes to the differential diagnosis of bacterial encephalitis and viral encephalitis.