降钙素原和基质金属蛋白酶-9在小儿颅内感染中的改变及其价值探讨

Value of procalcitonin, matrix metalloproteinase-9 in the differential diagnosis of intracranial infection in children

目的观察中枢神经系统感染患儿血清和脑脊液中降钙素原（PCT）、基质金属蛋白酶-9（MMP-9）水平的变化，探讨其对化脓性脑膜炎、病毒性脑炎的鉴别诊断价值。方法选取2014年9月至2015年12月青岛市妇女儿童医院神经内科病房收治的脑（膜）炎患儿73例，其中化脓性脑膜炎患儿22例（化脑组），病毒性脑炎患儿51例（病脑组）作为研究对象，并选择非感染性无热惊厥患儿20例作为对照组。所有受试者均于入院后24h内，在无菌条件下行腰椎穿刺采集脑脊液2．0mL，同时采取静脉血4mL，采用双抗体夹心法酶联免疫吸附试验（ELISA）检测血清、脑脊液MMP-9水平，电化学发光法检测血清、脑脊液PCT水平。多组间比较采用方差分析，组间两两比较应用SNK—q检验，阳性率显著性比较用四格表x^2检验，相关性分析采用直线相关分析法。结果化脑组患儿血清、脑脊液PCT水平明显高于对照组、病脑组，差异具有统计学意义（均P〈0．01），而病脑组PCT水平与对照组比较差异无统计学意义（P〉0．05）；化脑组患儿血清、脑脊液MMP-9水平明显高于对照组、病脑组，病脑组较对照组亦明显升高，差异均具有统计学意义（均P〈0．01）；化脑组患儿血清、脑脊液PCT异常升高率明显高于病脑组，差异具有统计学意义（均P〈0．01），而血清、脑脊液MMP-9异常升高率两组间差异无统计学意义（P〉0．05）；直线相关分析显示，化脑组PCT和MMP-9血清水平呈正相关（r=0．694，P〈0．01），脑脊液PCT和MMP-9水平也呈正相关（r=0．498，P〈0．01），而病脑组血清、脑脊液PCT含量基本正常，与MMP-9无相关性（均P〉0．05）。结论联合检测血清、脑脊液PCT、MMP-9水平对化脓性脑膜炎、病毒性脑炎的鉴别诊断具有一定的临床价值。

Objective To observe the serum and cerebrospinal fluid （CSF） levels of procalcitonin （PCT）, matrix metalloproteinase-9 （MMP-9） in children with purulent meningitis and viral encephalitis, and evaluat the differential diagnosis value of PCT and MMP-9. Methods The clinical data of 73 patients with intracranial infection admitted to neurology of Qingdao Women and Children＇ s Hospital from September 2014 to December 2015. Twenty-two patients with pumlent meningitis were selected as purulent meningitis group, 51 patients with viral encephalitis as viral encephalitis group, and another 20 non-infectious convulsion children as a control group. Samples of 2 ml CSF and 3 ml venous blood from all the subjects were collected within 24 hours after admission. The levels of MMP-9 were detected by Enzymelinked immunosorbent assay （ELISA）, and the PCT levels were measured by electrochemiluminescence immunoassay. The data in multiple groups were compared with analysis of variance, and by SNK-q test to carry on pairwise comparison among groups. The positive rate significance compared by Chi-square test. Linear correlation analysis was used for correlation analysis. Results Mean serum and CSF levels of PCT in the purulent meningitis patients group were significantly higher than those in the viral encephalitis group as well as the control group （P 〈 0. 01 ）, but the levels of serum or CSF there were no significant difference between the viral encephalitis group and the control group （ P 〉 0.05 ） ; Mean serum and CSF levels of MMP-9 in the pumlent meningitis patients group were significantly higher than those in the viral encephalitis group and control group （P 〈 0. 01 ）, and the levels in patients with viral encephalitis were significantly higher than those in control group （ P 〈 0. 01 ） ; The increased percentage of the serum and CSF PCT in pumlent meningitis group were significantly higher than in viral encephalitis group （P 〈 0.01 ） . but there were no significant difference for MMP-9 （ P 〉 0.05 ） ; The PCT level of serum or CSF in pumlent meningitis patients was positively correlated with MMP-9 （r = 0. 498, P 〈 0. 01 ）, but there was no significant correlation in viral encephalitis group （P 〉 0. 05） . Conclusion Detection of PCT and MMP-9 level is valuable in differential diagnosis for the purulent meningitis or viral encephalitis.