脑脊液中纤维连接蛋白、血管内皮生长因子及乳酸脱氢酶水平在儿童细菌性脑膜炎和病毒性脑炎中的诊断价值

Value of fibronectin,vascular endothelial growth factor and lactate dehydrogenas levels in cerebrospinal fluid in diagnosing bacterial meningitis and viral encephalitis in children

目的探讨脑脊液中纤维连接蛋白(FN)、血管内皮生长因子(VEGF)及乳酸脱氢酶(LDH)水平在鉴别诊断儿童细菌性脑膜炎(BM)和病毒性脑炎(VE)中的价值。方法选取31例BM患儿(BM组)、34例VE患儿(VE组)及26例非中枢神经系统(CNS)感染患儿(对照组)为研究对象。采用酶联免疫吸附法(ELISA)检测3组患儿治疗前后脑脊液中FN、VEGF、LDH水平;采用受试者工作特征(ROC)曲线分析FN、VEGF及LDH对BM、VE的鉴别诊断价值,采用Pearson系数分析三者的相关性。结果治疗前,BM组FN、VEGF、LDH水平均高于对照组及VE组,VE组FN水平低于对照组,差异有统计学意义(P<0.05)。治疗后,BM组FN、VEGF、LDH水平降低,VE组FN、LDH水平均降低,差异有统计学意义(P<0.05)。FN、VEGF及LDH鉴别诊断BM组与VE组、BM组和对照组的ROC曲线下面积(AUC)均>0.9,FN鉴别诊断VE组和对照组的AUC>0.8,但VEGF及LDH鉴别诊断VE组和对照组的AUC<0.6。BM组中FN、VEGF及LDH之间两两呈正相关,VE组中VEGF与LDH呈正相关,而对照组中FN、VEGF及LDH之间无相关性。结论检测脑脊液中FN、VEGF、LDH水平对BM、VE和非CNS感染的鉴别诊断具有一定临床价值。

Objective To investigate the values of fibronectin(FN),vascular endothelial growth factor(VEGF)and lactate dehydrogenas(LDH)levels in cerebrospinal fluid in differential diagnosis of children with bacterial meningitis(BM)and viral encephalitis(VE).Methods Thirty-one children with BM(BM group),thirty-four children with VE(VE group)and twenty-six children without central nervous system(CNS)infection(control group)were collected as research subjects.The levels of FN,VEGF and LDH in the cerebrospinal fluid of the three groups before and after treatment were detected by enzyme linked immunosorbent assay(ELISA);Receiver Operating Characteristic(ROC)curve was used to analyze the differential diagnostic values of FN,VEGF and LDH for BM and VE,the correlation of the three indicators were analyzed by Pearson coefficient.Results Before treatment,the levels of FN,VEGF and LDH in the BM group were significantly higher than those in the control group and the VE group,and the level of FN in the VE group was significantly lower than that in the control group(P<0.05).After treatment,the levels of FN,VEGF and LDH in the BM group were significantly decreased,and the levels of FN and LDH in the VE group were significantly decreased(P<0.05).The area under the ROC curve(AUC)of FN,VEGF and LDH in differential diagnosis of the BM group and the VE group,the BM group and the control group were all more than 0.9,the AUC of FN in differential diagnosis of the VE group and the control group was more than 0.8,but the AUC of VEGF and LDH in differential diagnosis of the VE group and the control group were less than 0.6.There was positive correlations between FN,VEGF and LDH in the BM group,and a positive correlation between VEGF and LDH in the VE group,while there was no correlation between FN,VEGF and LDH in the control group.Conclusion Detection the levels of FN,VEGF and LDH in cerebrospinal fluid has certain clinical value in the differential diagnosis of BM,VE and non-CNS infections.