HBP联合PCT在中枢神经系统感染患儿的诊断价值

Diagnostic value of heparin-binding protein combined with procalcitonin for children diagnosed with central nervous system infection

目的探讨血浆与脑脊液肝素结合蛋白(HBP)、降钙素原(PCT)检测在中枢神经系统感染患儿的临床诊断价值。方法选取2016年9月至2018年1月在浙江省台州市中心医院儿科病房收治的中枢神经系统感染患儿97例,其中化脓性脑膜炎患儿39例(化脑组),病毒性脑膜炎患儿35例(病脑组),结核性脑膜炎患儿23例(结脑组),另随机选取30例非感染性无热惊厥患儿作为正常对照组。分析四组受试者血浆与脑脊液HBP和PCT水平差异及相关性,并采用受试者工作特征曲线(ROC)来评价各指标单项及联合检测在诊断细菌性脑膜炎的价值。结果化脑组患儿血浆和脑脊液HBP、PCT水平均明显高于病脑组、结脑组和对照组,差异均具有统计学意义(P<0.05)。病脑组血浆和脑脊液PCT水平与对照组相比,差异无统计学意义(P>0.05)。化脑组和结脑组患儿血浆、脑脊液HBP和PCT水平均呈正相关关系(r值分别为0.544、0.627、0.461和0.552,均P<0.01)。病脑组患儿血浆和脑脊液HBP、PCT水平均无明显相关性(r值分别为0.127、0.204,均P>0.05)。血浆HBP和PCT单项及联合检测在诊断化脓性脑膜炎的曲线下面积(AUC)分别为0.866(95%CI:0.779~0.952,P<0.01)、0.777(95%CI:0.667~0.888,P<0.01,)和0.943(95%CI:0.893~0.994,P<0.01)。当血浆HBP和PCT取27.76 ng/mL和0.23 ng/mL为cut-off时,联合检测时的准确度均较单项检测明显提高,差异均具有统计学意义(χ^2=44.997,P<0.05)。脑脊液HBP和PCT单项及联合检测在诊断化脓性脑膜炎的AUC分别为0.907(P<0.01,95%CI:0.838~0.976)、0.810(95%CI:0.708~0.911,P<0.01)和0.952(95%CI:0.902~0.972,P<0.01)。当脑脊液HBP和PCT取21.07ng/mL和0.12ng/mL为cut-off时,联合检测时的特异度、准确度均较单项检测明显提高,差异均具有统计学意义(χ^2值分别为11.006、26.118,均P<0.05)。结论血浆与脑脊液HBP、PCT水平对化脓性脑膜炎患儿具有较高的价值,是鉴别小儿中枢系统感染类型的有效指标。二者在血浆与脑脊液中联合检测均可提高化脓性脑膜炎患儿的检出率和准确度。

Objective To investigate the clinical diagnostic value of heparin-binding protein(HBP) and procalcitonin(PCT) in plasma and cerebrospinal fluid for children diagnosed with central nervous system infection.Methods Ninety-seven children diagnosed with central nervous system infection and admitted to the pediatric ward of Taizhou Central Hospital in Zhejiang Province from September 2016 to January 2018 were enrolled,including 39 children with purulent meningitis(purulent meningitis group),35 children with viral meningitis(viral meningitis group) and 23 children with tuberculous meningitis(tuberculous meningitis group).In addition,30 children without infectious disease and febrile convulsions were randomly selected as normal control group.The differences and correlations of HBP and PCT levels in plasma and cerebrospinal fluid in the four groups were analyzed,and the receiver operating characteristic(ROC) curve was used to evaluate the value of single indicators and combined detection in the diagnosis of bacterial meningitis.Results The levels of HBP and PCT in plasma and cerebrospinal fluid of children in purulent meningitis group were significantly higher than those of other groups(all P<0.05).There was no significant difference in PCT levels in plasma and cerebrospinal fluid between the viral meningitis group and the control group(both P>0.05).There was positive correlation between HBP and PCT levels in plasma and cerebrospinal fluid for purulent meningitis group and tuberculous meningitis group(r=0.544,0.627,0.461 and 0.552,respectively,all P<0.01).There was no significant correlation between HBP and PCT levels in plasma and cerebrospinal fluid for viral meningitis group(r=0.127 and 0.204,respectively,both P>0.05).The area under curve(AUC) of single and combined detection of HBP and PCT in plasma for diagnosis of purulent meningitis were 0.866(95%CI:0.779-0.952,P<0.01),0.777(95%CI:0.667-0.888,P<0.01) and 0.943(95%CI:0.893-0.994,P<0.01).When 27.76 ng/mL of plasma HBP and 0.23 ng/mL of plasma PCT were taken as the cut-off values,the accuracy of combined detection was significantly higher than that of single detection(χ^2=44.997,P<0.05).The AUC of single and combined detection of HBP and PCT in cerebrospinal fluid for diagnosis of purulent meningitis were 0.907(95%CI:0.838-0.976,P<0.01),0.810(95%CI:0.708-0.911,P<0.01) and 0.952(95%CI:0.902-0.972,P<0.01).When 21.07 ng/mL of HBP and 0.12 ng/mL of PCT in cerebrospinal fluid were taken as the cut-off values,the specificity and accuracy of combined detection was significantly higher compared with the single detection,and the differences were statistically significant(χ^2Symbol}@@11.006 and 26.118,respectively,both P<0.05) ConclusionHBP and PCT levels in plasma or cerebrospinal fluid are of high value in children with bacterial intracranial infection and are effective indicators for identifying types of central nervous system infection.The combined detection of HBP and PCT in plasma and cerebrospinal fluid could improve the detection rate and accuracy in diagnosis of purulent meningitis.