MMP9及TIMP1在小儿病毒性脑炎及细菌性脑膜炎鉴别诊断中的价值

Value of MMP9 and TIMP-1 in Differential Diagnosis of Viral Encephalitis and Bacterial Meningitis in Children

目的:分析病毒性脑炎及细菌性脑膜炎患儿血清及脑脊液中基质金属蛋白酶9(MMP9)及基质蛋白酶组织抑制因子1(TIMP1)的表达及在鉴别诊断该两种疾病中的价值。方法:收集病毒性脑炎患儿36例(病脑组),细菌性脑膜炎患儿34例(化脑组),非中枢神经系统感染患儿30例为对照组,检测三组患儿入院24h内血清及脑脊液中MMP9及TIMP1水平,比较三组间及不同严重程度患儿间MMP9、TIMP1、MMP9/TIMP1水平的差异。ROC曲线分析MMP9、TIMP1、MMP9/TIMP1鉴别病毒性脑炎和细菌性脑膜炎的价值。结果:与对照组相比,病脑组和化脑组的血清及脑脊液MMP9、TIMP1、MMP9/TIMP1水平均显著升高(P<0.05);与病脑组相比,化脑组血清及脑脊液MMP9、MMP9/TIMP1水平显著升高(P<0.05);病脑及化脑组内重度患儿血清及脑脊液MMP9、MMP9/TIMP1水平均显著高于轻度患儿(P<0.05);血清MMP9、脑脊液MMP9及脑脊液MMP9/TIMP1鉴别病毒性脑炎和细菌性脑膜炎的性能较好(AUC分别为0.851、0.965、0.811,均P<0.05)。结论:血清及脑脊液MMP9及MMP9/TIMP1鉴别诊断病毒性脑炎和细菌性脑膜炎的性能较好,可作为临床辅助诊断指标。

Objective:To analyze the expression of matrix metalloproteinase-9(MMP9)and tissue inhibitor of matrix proteinase-1(TIMP1)in serum and cerebrospinal fluid of viral encephalitis or bacterial meningitis children and their value in differential diagnosis of these two diseases.Methods:36 children with viral encephalitis(VE group),34 children with bacterial meningitis(BM group)were collected,and 30 children without central nervous system infection as the control group.MMP9 and TIMP1 levels in serum and cerebrospinal fluid of the three groups were detected within 24 hours after hospitalization.The levels of MMP9,TIMP1 and MMP9/TIMP1 were compared among the three groups and between different severity subgroups.ROC curve was used to analyze the value of MMP9,TIMP1 and MMP9/TIMP1 in differentiating viral encephalitis from bacterial meningitis.Results:Compared with the control group,the levels of MMP9,TIMP1,MMP9/TIMP1 in serum and cerebrospinal fluid in the VE group and BM group were significantly increased(P<0.05).Compared with the VE group,the levels of MMP9 and MMP9/TIMP1 in serum and cerebrospinal fluid in the BM group were significantly increased(P<0.05).The levels of MMP9 and MMP9/TIMP1 in serum and cerebrospinal fluid in severe children were significantly higher than those in mild children(P<0.05).Serum MMP9,cerebrospinal fluid MMP9 and cerebrospinal fluid MMP9/TIMP1 showed better performance in differentiating viral encephalitis from bacterial meningitis(AUC=0.851,0.965,0.811,P<0.05).Conclusion:Serum and cerebrospinal fluid MMP9 and MMP9/TIMP1 have good performance in differential diagnosis of viral encephalitis and bacterial meningitis,and can be used as clinical auxiliary diagnostic indexes.