肠道病毒71型脑炎患儿血清和脑脊液神经元特异性烯醇化酶、S-100β蛋白及髓鞘碱性蛋白的测定

Detection of neuron specific enolase,S-100β and myelin basic protein levels in serum and cerebrospinal fluid of children with EV71 encephalitis

目的探讨肠道病毒71型(enterovirus A group type 71,EV71)脑炎患儿血清和脑脊液(Cerebrospinal fluid,CSF)中神经元特异性烯醇化酶(NSE)、S-100β蛋白和髓磷脂碱性蛋白(MBP)的水平变化及其临床意义。方法依据卫生部《肠道病毒71型(EV71)感染重症病例临床救治专家共识》的诊断标准,将患儿分为普通病例组、重症病例组(再分为重症重型组和重症危重型组),同时设立对照组。应用双抗体夹心酶联免疫吸附测定(ELISA)法分别检测各组患儿不同时期血清、CSF中S-100β和MBP的水平;采用电化学发光法检测各组患儿不同时期血清、CSF中NSE的水平。结果重症危重型组和重症重型组中,血清和CSF中NSE以及S-100β水平均显著高于普通病例组和对照组,差异有统计学意义;重症危重型组CSF中NSE、S-100β水平也高于重症重型组,差异有统计学意义;普通病例组血清和CSF中NSE、S-100β水平与对照组差异无统计学意义。重症病例组急性期血清和CSF中NSE、S-100β含量均显著高于恢复期和对照组,差异有统计学意义,但恢复期血清和CSF中NSE、S-100β含量与对照组差异无统计学意义;各组血清和CSF中MBP水平差异无统计学意义。重症病例组血清与CSF中NSE和S-100β的含量均呈正相关(r=0.886,P<0.01;r=0.875,P<0.01)。结论检测EV71脑炎患儿血清和CSF中NSE、S-100β水平,可评估其脑损伤程度及预后。

Objective To explore the change and its clinical significance of neuron specific enolase（ NSE）,S-100β and myelin basic protein（ MBP） levels in serum and cerebrospinal fluid（ CSF） of children with EV71 encephalitis. Methods According to ＂Expert consensus on severe EV71 infection treatment＂,the sick children were divided into three group,i. e.mild case group,severe cases group and critical case group,and a control group was set. The concentrations of NSE in serum and CSF samples of children of each group in different phases were detected by electrochemiluminescence method,and the concentrations of S-100β and MBP in serum and CSF samples of children of each group in different phases were detected by double antibody sandwich ELISA. Results The serum and CSF levels of NSE and S-100β of severe cases and critical cases were significantly higher than those of the mild cases and control respectively（ P〈0. 01）. The serum and CSF levels of NSE and S-100β in critical cases were higher than those in severe cases（ P〈0. 05 or P〈0. 01）. The difference in serum and CSF levels of NSE and S-100β was significant between mild cases and controls. The serum and CSF levels of NSE and S-100βof severe cases / critical cases in acute phase were significantly higher than those inconvalescencephase of severe / critical cases and the controls（ P〈0. 01）,but the difference in serum and CSF levels of NSE and S-100β had no significant between severe / critical cases in convalescencephase and controls. The group specific differences in serum and CSF level of MBP had no significance. Positive correlation between NSE level and S-100β level in serum and CFS samples were observed in severe cases（ r = 0. 886,0. 875,P〈0. 01）. Conclusion Detection of serum and CFS levels of NSE and S-100β in children with EV71 encephalitis might be helpful in assessment of brain damage and prognosis of EV71 encephalitis.