不同中枢神经系统感染患儿血清和脑脊液炎症标记物及MMP-9水平及临床意义

Levels of Inflammatory Markers and MMP-9 in Serum and Cerebrospinal Fluid of Children with Different Central Nervous System Infection and Its Significances

目的:探讨不同中枢神经系统感染患儿血清和脑脊液中炎症标记物及基质金属蛋白酶9(Matrix metallo protein 9,MMP-9)的水平及临床意义。方法:选取本院2017年8月至2018年6月收治的198例脑膜炎儿童患者分为感染组,根据不同患病原因分成化脓性脑膜炎(Purulent Meningitis,PM=107例)和病毒性脑膜炎(Viral Meningitis,VM=91例),另选取同期58例体检健康儿童作为对照组(Normal Control,NC=58例)。采用双抗夹心免疫荧光发光法检测患者血清和脑脊液(Cerebrospinal fluid,CF)中降钙素原(Prcoalcitonin,PCT)水平;采用免疫荧光分析仪检测患者血清和脑脊液内C反应蛋白(C-reactionprotein,CRP)水平;酶联免疫吸附实验(ELISA)检测三组患儿治疗前后血清和脑脊肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)及MMP-9表达水平;电化学发光全自动免疫分析仪分析血清白蛋白和脑脊液白蛋白含量,并计算白蛋白指数。结果:与对照组相比,化脑组和病脑组患儿血清和脑脊液中CRP、PCT、TNF-α及MMP-9水平均明显增高(P<0.05),化脑组患儿血清和脑脊液中CRP、PCT、TNF-α及MMP-9水平显著高于病脑组(P<0.05)。与对照组相比,化脑组患儿治疗前、治疗72小时和治疗1周后血清和脑脊液PCT水平降低(P<0.05),与对照组相比,病脑组患儿治疗前后血清和脑脊液PCT水平表达差异无统计学意义(P>0.05);化脑组和病脑组患儿脑脊液中CRP、PCT、TNF-α及MMP-9水平与患儿白蛋白指数均呈正相关。结论:血清和脑脊液炎症标记物及MMP-9变化可对化脓性脑膜炎和病毒性脑膜炎进行初步的鉴别。

Objective: To investigate levels of inflammatory markers and matrix metalloproteinase-9(MMP-9) in serum and cerebrospinal fluid of children with central nervous system infection and its clinical significance. Methods: 198 children with meningitis admitted to our hospital from August 2017 to June 2018 were divided into infection group. They were divided into purulent meningitis(PM=107) and viral meningitis(VM=91) according to different causes. 58 healthy children were selected as control group(Normal Control, NC=58) during the same period. The levels of procalcitonin(PCT) in serum and cerebrospinal fluid(CF) were detected by double antibody sandwich immunofluorescence assay;the levels of C-reactive protein(CRP) in serum and cerebrospinal fluid were detected by immunofluorescence analyzer;the levels of Tumor necrosis factor-alpha(TNF-alpha) and MMP-9 in serum and cerebrospinal fluid were detected by enzyme-linked immunosorbent assay(ELISA) before and after treatment in three groups of children;the serum White was analyzed by electrochemiluminescence automatic immunoanalyzer. Protein and cerebrospinal fluid albumin content, and calculate albumin index. Results: Compared with the control group, the levels of CRP, PCT, TNF-α and MMP-9 in serum and cerebrospinal fluid of the patients in the Huanao group and the diseased brain group were significantly higher(P<0.05), and the levels of CRP, PCT, TNF-α and MMP-9 in the serum and cerebrospinal fluid of the patients in the Huanao group were significantly higher than those in the diseased brain group(P<0.05). Compared with the control group, PCT levels in serum and cerebrospinal fluid of children in the Huanao group decreased before treatment, 72 hours after treatment and 1 week after treatment(P<0.05). There was no significant difference in PCT levels in serum and cerebrospinal fluid between the two groups before and after treatment(P>0.05). CRP, PCT,TNF-alpha and MMP-9 levels in the cerebrospinal fluid of children in the Huanao group and the sick cerebrospinal group were similar to those of children with albumin index positive correlation. Conclusion: The levels of inflammatory markers and MMP-9 in serum and cerebrospinal fluid can be used to differentiate suppurative meningitis from viral meningiti.