化脓性脑膜炎、病毒性脑炎患儿血清降钙素原和基质金属蛋白酶9的变化研究

Serum levels of procalcitonin and MMP-9 in children with purulent meningitis and viral encephalitis

目的探讨血清降钙素原(PCT)、基质金属蛋白酶9(MMP-9)在化脓性脑膜炎、病毒性脑炎中的临床诊断价值。方法选择化脓性脑膜炎患儿20例(化脑组),病毒性脑炎患儿31例(病脑组)作为研究对象,非感染性无热惊厥患儿20例作为对照组。采用电化学发光法测定血清PCT浓度,双抗体夹心法酶联免疫吸附实验(ELISA)检测血清MMP-9水平。结果 3组血清PCT、MMP-9水平比较,差异有统计学意义(P<0.05);化脑组血清PCT水平高于对照组、病脑组(P=0.001和0.003),病脑组PCT水平与对照组比较差异无统计学意义(P=0.851);化脑组血清MMP-9水平高于对照组和病脑组(P=0.005和0.009),病脑组较对照组亦升高(P=0.007)。化脑组血清PCT异常升高率高于病脑组,差异有统计学意义(χ2=68.210,P=0.000),而血清MMP-9异常升高率两组间比较,差异无统计学意义(χ2=0.252,P=0.833)。经直线相关分析,化脑组血清PCT、MMP-9浓度与血白细胞(WBC)、C反应蛋白(CRP)、脑脊液WBC、脑脊液清蛋白呈正相关,与脑脊液葡萄糖浓度呈负相关(P<0.05),与脑脊液氯化物水平无相关性(P>0.05),PCT和MMP-9血清水平呈正相关(r=0.694,P<0.05);病脑组血清PCT与血WBC、CRP以及脑脊液WBC、脑脊液清蛋白、葡萄糖、脑脊液氯化物水平均无相关性(P>0.05),MMP-9与脑脊液清蛋白水平呈正相关(P<0.05),与血WBC、CRP以及脑脊液WBC、葡萄糖、氯化物水平均无相关性(P>0.05),PCT和MMP-9血清水平无相关性(r=0.044,P>0.05)。结论化脑组血清PCT、MMP-9水平均明显升高,而病脑组仅MMP-9水平升高,检测PCT、MMP-9血清浓度对化脓性脑膜炎、病毒性脑炎的诊断、鉴别诊断具有重要的临床意义。

Objective To study the diagnostic value of serum levels of procalcitonin(PCT)and matrix metalloproteinase 9(MMP-9)in children with purulent meningitis and viral encephalitis.Methods Twenty children with purulent meningitis were selected as purulent meningitis group,31 patients with viral encephalitis as viral encephalitis group,and 20 non-infectious convulsion children as control group.The serum PCT 1evels were measured by electrochemiluminescence immunoassay,and serum MMP-9 levels were detected by enzyme-linked immunosorbent assay.Results The mean serum level of PCT in the purulent meningitis group was significantly higher than that in the viral encephalitis group and the control group(P=0.001 and 0.003),however,there was no significant difference between the viral encephalitis group and the control group(P=0.851).The mean serum level of MMP-9 in the purulent meningitis group was significantly higher than that in the viral encephalitis group and the control group(P=0.005 and 0.009),and the MMP-9 level in the viral encephalitis group was significantly higher than that in the control group(P=0.007).The rate of abnormal increase of serum PCT in the purulent meningitis group was significantly higher than that in the viral encephalitis group(χ2=68.210,P=0.000),but there was no significant difference in the rate of abnormal increase of serum MMP-9 between the two groups(χ2=0.252,P=0.833).In the purulent meningitis group,serum PCT and MMP-9 levels were positively correlated with white blood cell(WBC)count and C-reactive protein(CRP)in blood,WBC count and protein levels in cerebrospinal fluid(CSF)(P<0.05),and negatively correlated with the CSF glucose(P<0.05),but not correlated with chloride in CSF;and serum PCT level was positively correlated with serum MMP-9 level(r=0.694,P<0.05).In the viral encephalitis group,serum PCT level had no correlation with serum WBC,serum CRP,CSF WBC count,protein,glucose or chloride level(P>0.05);serum MMP-9 level had a positive correlation with CSF protein level(P<0.05),but no correlation with serum WBC,serum CRP,CSF WBC count,glucose or chloride level(P>0.05);serum PCT level was not correlated with serum MMP-9 level either(r=0.044,P>0.05).Conclusions Both serum PCT and MMP-9 levels significantly increase in purulent meningitis children,while only serum MMP-9 level increases significantly in viral encephalitis patients.Detection of serum PCT and MMP-9 levels is valuable in the diagnosis and differential diagnosis of purulent meningitis and viral encephalitis.