TNF-α,IL-6,BlyS,APRIL水平在病毒性脑炎诊断及预后评估中的应用价值

The value of TNF-α,IL-6,BlyS,and APRIL levels in the diagnosis and prognosis evaluation of viral encephalitis

目的探讨肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、B淋巴细胞刺激因子(B lymphocyte stimulator,BlyS)、增殖诱导配体(A proliferation-inducingligand,APRIL)水平检测在病毒性脑炎诊断和预后评估中的应用价值。方法选取2017年1月-2018年6月在本院接受治疗的132例病毒性脑炎患者作为研究组,同时纳入同期以疑似颅内感染入院,经检查为正常的60名体检健康者作为对照组;将研究组患者根据入院时的病情和治疗后的预后情况进行分组,检测并比较各组研究对象的血清和脑脊液TNF-α,IL-6,BlyS,APRIL水平,应用Pearson相关性分析对脑脊液和血清TNF-α,IL-6,BlyS,APRIL水平进行分析,通过受试者工作特征(Receiver operating characteristic,ROC)曲线评价其在病毒性脑炎诊断和预后评估中的应用价值。结果研究组血清和脑脊液TNF-α,IL-6,BlyS,APRIL水平均显著高于对照组,重症组血清和脑脊液TNF-α,IL-6,BlyS,APRIL水平均显著高于轻症组,且研究组处于急性期患者的血清和脑脊液TNF-α,IL-6,BlyS,APRIL水平均显著高于处于恢复期的患者(P<0.05);研究组遗留后遗症患者的血清和脑脊液TNF-α,IL-6,BlyS,APRIL水平均显著高于无后遗留症患者(P<0.05);研究组脑脊液TNF-α,IL-6,BlyS,APRIL水平分别与血清TNF-α,IL-6,BlyS,APRIL水平均呈正相关(r=0.407,0.383,0.281,0.257,P<0.01);ROC曲线分析显示,脑脊液和血清TNF-α,IL-6,BlyS,APRIL水平联合检测诊断病毒性脑炎的曲线下面积(Area of the under curve,AUC)均明显高于单一指标水平检测,灵敏度和特异度也明显高于单一指标水平检测。结论病毒性脑炎患者脑脊液和血清TNF-α,IL-6,BlyS,APRIL水平均显著升高,其升高程度与患者病情严重程度及预后有关,而且脑脊液和血清TNF-α,IL-6,BlyS,APRIL水平存在明显相关性,脑脊液和血清4项指标水平的联合检测有助于临床病毒性脑炎的诊断和预后评价。

Objective To investigate the value of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),B lymphocyte stimulating factor(BlyS)and proliferation inducing ligand(APRIL)levels in the diagnosis and prognosis evaluation of viral encephalitis.Methods A total of 132 patients with viral encephalitis in our hospital from January 2017 to June 2018 were included in this study.60 healthy subjects were selected as the control group.The patients in the study group were grouped according to the condition at admission and the prognosis after treatment.The levels of TNF-α,IL-6,BlyS,APRIL in serum and cerebrospinal fluid were detected and compared in each group,and analyzed by Pearson correlation analysis.The diagnosis value was evaluated by ROC curve.Results The levels of TNF-α,IL-6,BlyS,APRIL in serum and cerebrospinal fluid in the study group were significantly higher than those in the control group.The levels of TNF-α,IL-6,BlyS and APRIL in serum and cerebrospinal fluid in the severe group were significantly higher than those in the mild group.The levels of TNF-α,IL-6,BlyS and APRIL in serum and cerebrospinal fluid of patients in the acute stage were significantly higher than those in the convalescent stage(P<0.05).The levels of TNF-α,IL-6,BlyS,APRIL in serum and cerebrospinal fluid of patients with sequelae were significantly higher than those of patients without sequelae(P<0.05).The levels of TNF-α,IL-6,BlyS,APRIL in cerebrospinal fluid were positively correlated with serum levels of TNF-α,IL-6,BlyS and APRIL in the study group(P<0.05).ROC curve analysis showed that the area under curve(AUC)of combined detection of TNF-α,IL-6,BlyS,APRIL levels in cerebrospinal fluid and serum for the diagnosis of viral encephalitis was significantly higher than that of single index detection,and the sensitivity and specificity were also significantly higher than that of single index detection.Conclusion The levels of TNF-α,IL-6,BlyS,and APRIL in cerebrospinal fluid and serum of patients with viral encephalitis are significantly elevated,which is related to the severity and prognosis of the disease.The combined detection of the four indexes in cerebrospinal fluid and serum is helpful for the diagnosis and prognosis of viral encephalitis.