中枢神经系统感染患儿血清和脑脊液CRP、PCT、TNF-α及MMP-9水平及其临床意义

Serum and Cerebrospinal Fluid CRP, PCT, TNF-α and MMP-9 Levels in Children with Central Nervous System Infection and Their Clinical Significance

目的:探讨中枢神经系统感染患儿血清和脑脊液C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)及基质金属蛋白酶-9(MMP-9)水平及其临床意义。方法:选择2017年1月~2018年6月期间南京市第二医院收治的中枢神经系统感染患儿93例作为研究对象,其中化脓性脑膜炎62例记为化脓性脑膜炎组,病毒性脑炎31例记为病毒性脑炎组,另选取同期于我院治疗的非中枢神经系统感染患儿40例作为对照组,比较各组血清、脑脊液CRP、PCT、TNF-α、MMP-9水平及阳性率,并计算血清和脑脊液CRP、PCT、TNF-α、MMP-9诊断中枢神经系统感染的灵敏度、特异度及准确度。结果:化脓性脑膜炎组患儿血清、脑脊液CRP、PCT、TNF-α及MMP-9水平及阳性率高于病毒性脑炎组和对照组,病毒性脑炎组患儿血清、脑脊液CRP、TNF-α及MMP-9水平及阳性率高于对照组(P<0.05),病毒性脑炎组与对照组血清、脑脊液PCT水平及阳性率比较无统计学差异(P>0.05)。血清或脑脊液CRP+PCT+TNF-α+MMP-9联合检验对中枢神经系统感染具有一定的诊断价值。结论:中枢神经系统感染患儿血清、脑脊液CRP、TNF-α、PCT及MMP-9水平明显升高,其中化脓性脑膜炎患儿血清、脑脊液PCT水平高于病毒性脑炎患儿,血清或脑脊液CRP、PCT、TNF-α及MMP-9联合检验对儿童中枢神经系统感染的鉴别诊断具有较高的价值。

Objective: To investigate the levels of C-reactive protein(CRP), procalcitonin(PCT), tumor necrosis factor-α(TNF-α)and matrix metalloproteinase-9(MMP-9) in serum and cerebrospinal fluid of children with central nervous system infection and their clinical significance. Methods: 93 children with central nervous system infection who were treated in Nanjing Second Hospital from January2017 to June 2018 were selected as subjects. 62 cases of purulent meningitis were classified as purulent meningitis group. 31 cases of viral encephalitis were classified as viral encephalitis group. Another 40 cases of non central nervous system infection treated in our hospital during the same period were selected as control group. The levels and positive rates of CRP, PCT, TNF-α and MMP-9 in serum and cerebrospinal fluid were compared. The sensitivity, specificity and accuracy of CRP, PCT, TNF-α and MMP-9 in serum and cerebrospinal fluid were calculated. Results: The levels and positive rates of CRP, PCT, TNF-α and MMP-9 in serum, cerebrospinal fluid of children with purulent meningitis were higher than those of viral encephalitis group and control group. The levels and positive rates of CRP, TNF-α and MMP-9 in serum, cerebrospinal fluid of children with viral encephalitis group were higher than those of control group(P<0.05). There was no significant difference in serum, cerebrospinal fluid PCT level and positive rate(P>0.05). The combined detection of CRP+PCT+TNF-α+MMP-9 in serum or cerebrospinal fluid has certain diagnostic value for central nervous system infection. Conclusion: The levels of CRP, TNF-α, PCT and MMP-9 in serum and cerebrospinal fluid of children with central nervous system infection are elevated. The level of PCT in serum and cerebrospinal fluid of children with purulent meningitis is higher than that of children with viral encephalitis. The combined tests of CRP, PCT, TNF-α and MMP-9 in serum or cerebrospinal fluid are of great value in differential diagnosis of children with central nervous system infection.