病毒性脑炎及化脓性脑膜炎患儿血清血管内皮细胞钙黏蛋白降钙素原的变化及意义

Changes and significance of serum vascular endothelial cell cadherin procalcitonin in children with viral encephalitis and suppurative meningitis

目的探讨血管内皮细胞钙黏蛋白(VE-cadherin)、血清降钙素原(PCT)在病毒性脑炎、化脓性脑膜炎患儿中的临床诊断价值。方法选择病毒性脑炎患儿62例(病脑组),化脓性脑膜炎患儿40例(化脑组)作为研究对象,无热惊厥非感染患儿40例作为对照组。采用酶联免疫吸附法(ELISA法)测定血清VE-cadherin、PCT浓度。结果3组血清VE-cadherin、PCT水平比较,差异有统计学意义(P<0.01)。化脑组血清VE-cadherin水平高于对照组、病脑组(P<0.01),病脑组高于对照组(P<0.01)。化脑组血清PCT水平高于对照组和病脑组(P<0.01),而病脑组PCT水平较对照组差异无统计学意义(P<0.01)。病脑组VE-cadherin异常升高率高于PCT,差异有统计学意义(P<0.01);化脑组血清VE-cadherin异常升高率为82.5%,PCT异常升高率为100%,两者比较差异有统计学意义(P<0.05)。2组间比较,化脑组血清VE-cadherin异常升高率差异无统计学意义(P>0.05);血清PCT异常升高率高于病脑组(P<0.05)。病脑组血清VE-cadherin与CSF清蛋白呈正相关(P<0.05),血清PCT水平与血WBC、CRP、CSF指标均无相关性(P>0.05),血清VE-cadherin与PCT水平无相关性(P>0.05);化脑组血清VE-cadherin、PCT浓度与血WBC、CRP、CSF清蛋白、CSFWBC均呈正相关(P<0.05),血清VE-cadherin和PCT水平呈正相关(P<0.05)。结论检测血清VE-cadherin、PCT浓度对病毒性脑炎、化脓性脑膜炎的诊断和鉴别诊断具有重要的临床意义。

Objective To study the diagnostic value of serum levels of VE-cadherin and procalcitonin(PCT)in children with viral encephalitis and purulent meningitis.Methods 62 patients with viral encephalitis were selected as viral encephalitis group,40 children with purulent meningitis were selected as purulent meningitis group,and 40 non-infectious convulsion children were selected as control group.The VE-cadherin and PCT serum 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<0.05),however,there was nosignificant difference between the viral encephalitis group and the control group(P>0.05).The mean serum level of VE-cadherin in the purulent meningitis group was significantly higher than that in the viral encephalitis group and the control group(P<0.05),and the VE-cadherin level in the viral encephalitis group was significantly higher than that in the control group(P<0.05).The rate of abnormal increase of serum PCT in the purulent meningitis group was significantly higher than that in the viral encephalitis group(P<0.05),but there was no significant difference in the rate of abnormal increase of serum VE-cadherin between the two groups(P>0.05).In the purulent meningitis group,serum PCT and VE-cadherin 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 VE-cadherin level(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 VE-cadherin 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 VE-cadherin level either(P>0.05).Conclusion Both serum PCT and VE-cadherin levels significantly increase in purulent meningitis children,while only serum VE-cadherin level increases significantly in viral encephalitis patients.Detection of serum PCT and VE-cadherin levels is valuable in the diagnosis and differential diagnosis of purulent meningitis and viral encephalitis.