脑脊液可溶性髓系细胞触发受体-1、白介素-6及白介素-10在儿童化脓性脑膜炎中的诊断价值

The Diagnostic Value of Cerebrospinal Fluid Soluble Triggering Receptor Expressed on Myeloid Cells-1, Interleukin-6 and Interleukin-10 in Children with Purulent Meningitis

目的探讨脑脊液中可溶性髓系细胞触发受体-1 (s TREM-1)、IL-6及IL-10在儿童化脓性脑膜炎中的诊断价值。方法选择2019年1月至2020年1月在昆明医科大学附属儿童医院住院确诊中枢感染患儿62例,其中化脓性脑膜炎(PM)组30例、以病毒性脑炎(VM)组32例为对照组,测定并分析脑脊液中s TREM-1、IL-6、IL-10及WBC水平,应用ROC曲线研究s TREM-1、IL-6、IL-10和WBC的诊断效能。结果PM组脑脊液中s TREM-1、IL-6及IL-10水平均显著高于VM组,两组之间差异均有统计学意义(P <0.01);PM组脑脊液中WBC高于VM组,差异有统计学意义(P <0.05);s TREM-1、 IL-6、 IL-10、 WBC及s TREM-1+IL-6+IL-10诊断PM的ROC曲线下面积分别为0.867、0.754、0.781、0.651、0.921。当s TREM-1、IL-6、IL-10和WBC的cutoff值分别为285 pg/m L、137.16 pg/m L、21.97 pg/m L、18×10^6/L时,诊断PM的灵敏性分别为78.5%、67.9%、60.7%、32.3%;特异性分别为83.9%、77.4%、83.9%、96.4%;阳性预测值分别为81%、73%、76%、56%;阴性预测值分别为81%、73%、68%、91%。结论脑脊液s TREM-1、IL-6及IL-10在儿童PM与VM的鉴别诊断中具有一定的诊断价值,三者联合使用可提高对PM的临床诊断价值。

Objective To investigate the diagnostic value of soluble Triggering receptor expressed on myeloid cells-1(s TREM-1), IL-6 and IL-10 in cerebrospinal fluid in children with purulent meningitis. Methods A total of 62 children with central infection were diagnosed and admitted to the Children’s Hospital of Kunming Medical University from January 2019 to January 2020, of which 30 were in the purulent meningitis.(PM) group and 32 were in the viral meningitis(VM) group served as a control group, the levels of s TREM-1, IL-6, IL-10 and WBC in cerebrospinal fluid were measured and analyzed,and the ROC curve of receiver operating characteristics was used to study the diagnostic efficacy of s TREM-1, IL-6, IL-10, and WBC. Results The levels of s TREM-1, IL-6 and IL-10 in the cerebrospinal fluid of the PM group were significantly higher than those in the VM group, and there were statistical significance between the two groups(P < 0.01). The WBC in the cerebrospinal fluid of the PM group was higher than that of the VM group, the difference was statistically significant(P < 0.05);the area under the ROC curve for s TREM-1, IL-6,IL-10,WBC and s TREM-1 + IL-6 + IL-10 in diagnosis of PM were 0.867,0.754,0.781,0.651 and 0.921,respectively. The sensitivity of these makers were78.5%,67.9%,60.7%,32.3% respectively;the specificity were 83.9%,77.4%,83.9%,96.4% respectively;the positive predictive value were 81%,73%,76%,56% respectively and the negative predictive value81%,73%,68%,91% respectively while the cut-off values were 285 pg/m L,137.16 pg/m L,21.97 pg/m L,18×10^6/L. Conclusion s TREM-1、IL-6 and IL-10 in CSF have certain diagnostic value in the differential diagnosis of PM and VM.A combination of the three marks can improve clinical diagnostic value.