病毒性脑炎及细菌性脑膜炎患儿血清及脑脊液血管内皮细胞钙黏蛋白、降钙素原的变化及意义

Changes and significances of vascular endothelial cadherin,procalcitonin in serum and cerebrospinal fluid of children with viral encephalitis or bacterial meningitis

目的探讨病毒性脑炎及细菌性脑膜炎(BM)患儿血清及脑脊液中血管内皮细胞钙黏蛋白(VE-cadherin)、降钙素原(PCT)的变化及意义。方法选取2016年9月至2018年6月郑州大学第三附属医院确诊为病毒性脑炎患儿42例(病毒性脑炎组)、BM患儿36例(BM组),并将同期经检查证实无神经系统损伤的患儿20例作为对照组。3组均采用酶联免疫吸附法检测其脑脊液、血清中的VE-cadherin、PCT水平。结果急性期病毒性脑炎组、BM组和对照组患儿血清VE-cadherin水平分别为(5.60±1.17)mg/L、(7.08±1.01)mg/L、(2.52±0.68)mg/L,而脑脊液VE-cadherin水平分别为(6.00±1.09)mg/L、(6.97±1.11)mg/L、(1.93±0.88)mg/L。病毒性脑炎组、BM组及对照组血清PCT水平分别为(0.26±0.11)μg/L、(0.82±0.17)μg/L、(0.27±0.13)μg/L,脑脊液PCT水平分别为(0.25±0.11)μg/L、(0.72±0.14)μg/L、(0.28±0.17)μg/L。急性期BM组血清、脑脊液中VE-cadherin、PCT水平较病毒性脑炎组和对照组明显升高,差异均有统计学意义(F=124.94、163.21、151.62、127.37,均P<0.01)。病毒性脑炎组VE-cadherin水平较对照组亦明显升高,差异均有统计学意义(均P<0.01),但其PCT水平与对照组比较差异无统计学意义(均P>0.05)。治疗后病毒性脑炎组、BM组血清VE-cadherin水平分别为(2.34±0.81)mg/L、(2.67±1.29)mg/L,脑脊液VE-cadherin水平分别为(2.55±0.92)mg/L、(2.39±0.74)mg/L,而血清PCT水平分别为(0.25±0.11)μg/L、(0.30±0.17)μg/L,脑脊液PCT水平分别为(0.22±0.10)μg/L、(0.27±0.12)μg/L。经有效治疗后,BM组及病毒性脑炎组血清、脑脊液VE-cadherin、PCT水平比较差异均无统计学意义(F=1.83、0.76、2.72、3.89,均P>0.05)。受试者工作特征曲线显示,血清、脑脊液VE-cadherin在诊断中枢神经系统感染曲线下面积分别为0.896、0.912,PCT曲线下面积分别为0.670、0.668。结论VE-cadherin可能参与颅内感染早期发生过程,其与PCT在鉴别病毒及细菌感染方面具有一定参考意义。VE-cadherin对中枢神经系统感染具有较好的诊断价值。

Objective To investigate the changes and clinical significance of vascular endothelial(VE)-cadherin and procalcitonin(PCT)in serum and cerebrospinal fluid(CSF)of children with viral encephalitis or bacterial meningitis(BM).Methods A total of 42 cases of children with viral encephalitis(viral encephalitis group),36 cases of children with BM(BM group),and 20 cases of children with non-nervous system injury(control group)were selected from September 2016 to June 2018 at the Third Hospital of Zhengzhou University.The serum and CSF levels of VE-cadherin and PCT levels of the 3 groups were detected by using enzyme-linked immunosorbent assay.Results The levels of VE-cadherin in the serum of viral encephalitis group,BM group and control group at the acute phase were(5.60±1.17)mg/L,(7.08±1.01)mg/L and(2.52±0.68)mg/L respectively,and the levels of VE-cadherin in CSF of viral encephalitis group,BM group and control group were(6.00±1.09)mg/L,(6.97±1.11)mg/L and(1.93±0.88)mg/L,respectively.The levels of PCT in the serum of viral encephalitis group,BM group and control group at the acute phase were(0.26±0.11)μg/L,(0.82±0.17)μg/L and(0.27±0.13)μg/L,respectively,and the levels of PCT in the CSF of viral encephalitis group,BM group and control group were(0.25±0.11)μg/L,(0.72±0.14)μg/L,(0.28±0.17)μg/L,respectively.As a result,the levels of VE-cadherin and PCT in the serum and CSF of BM group showed significant increase,compared with viral encephalitis group and control group in the acute phase(F=124.94,163.21,151.62,127.37,all P<0.01).The levels of VE-cadherin in the serum and CSF of viral encephalitis group were also significantly higher than that of control group(all P<0.01),but there was no difference between viral encephalitis group and control group about the levels of PCT in the serum and CSF(all P>0.05).The levels of VE-cadherin in the serum of viral encephalitis group and BM group after treatment were(2.34±0.81)mg/L and(2.67±1.29)mg/L,and were(2.55±0.92)mg/L and(2.39±0.74)mg/L in the CSF.The levels of PCT in the serum of viral encephalitis group and BM group after treatment were(0.25±0.11)μg/L,(0.30±0.17)μg/L,and the levels of PCT in the CSF of viral encephalitis group and BM group were(0.22±0.10)μg/L and(0.27±0.12)μg/L.After effective treatment,the levels of VE-cadherin,PCT in serum and CSF of BM group and viral encephalitis group were almost equal,and the difference was not statistically significant(F=1.83,0.76,2.72,3.89,all P>0.05).In the receiver operating characteristic(ROC)curve,the area under the ROC curve of VE-cadherin in serum and CSF was 0.896 and 0.912,and was 0.670 and 0.668 of PCT respectively.Conclusions VE-cadherin may be involved in the early stage of intracranial infection,and it may be helpful in differentiation of virus or bacterial infection with PCT.VE-cadherin has a good diagnostic value for intracranial infection.