HBP、ADA、CHE对急性细菌性脑膜炎病原菌的鉴别诊断价值

Differential diagnosis value of heparin binding protein, adenosine deaminase and cholinesterase in cerebrospinal fluid to pathogenic bacteria of acute bacterial meningitis

目的 分析脑脊液肝素结合蛋白(HBP)、腺苷脱氨酶(ADA)、胆碱酯酶(CHE)对急性细菌性脑膜炎病原菌的鉴别诊断价值。方法 选择2016年1月至2020年11月首都医科大学附属北京潞河医院收治的急性细菌性脑膜炎患者128例的病历资料分析。依脑脊液病原体感染结果分为革兰阳性菌组(n=58)和革兰阴性菌组(n=70)。依据病情严重程度分为轻度组(n=35)、中度组(n=72)、重度组(n=21)。对比革兰阳性菌组和革兰阴性菌组患者的一般临床资料、脑脊液HBP、ADA、CHE水平。分析脑脊液HBP、ADA、CHE水平对急性细菌性脑膜炎病原菌的鉴别诊断价值。对比不同病情严重程度患者的脑脊液HBP、ADA、CHE水平。结果 革兰阳性菌组和革兰阴性菌组患者的一般临床资料比较,差异无统计学意义(P>0.05)。革兰阳性菌组和革兰阴性菌患者的脑脊液HBP、ADA比较,差异有统计学意义(t=5.924,5.650,P<0.05)。革兰阳性菌组和革兰阴性菌组患者的脑脊液CHE比较,差异无统计学意义(t=0.587,P>0.05)。脑脊液HBP、ADA、CHE水平对急性细菌性脑膜炎病原菌进行鉴别诊断分析,最佳截断值分别为213.82(ng/mL)、2.50(U/L)、151.63(U/L),约登指数分别为0.42、0.40、0.17。不同病情严重程度患者的脑脊液HBP、ADA、CHE比较,重度组>中度组>轻度组,差异有统计学意义(F=17.332、17.332、13.994,P均<0.05)。结论 在急性细菌性脑膜炎患者的脑脊液标本中,HBP、CHE、ADA的水平均明显提升,其浓度随着患者病情严重程度提升而增高。其中HBP和ADA对急性细菌性脑膜炎的病原体鉴别具有一定的意义。

Objective To analyze the differential diagnosis value of cerebrospinal fluid heparinbinding protein(HBP),adenosine deaminase(ADA)and cholinesterase(CHE)to pathogenic bacteria of acute bacterial meningitis. Methods The medical records of 128 patients with acute bacterial meningitis treated in Beijing Luhe Hospital Affiliated to Capital Medical University from January 2016 to November 2020 were analyzed. The patients were divided into grampositive bacteria group(n=58)and gramnegative bacteria group(n=70)according to the results of pathogen infection of cerebrospinal fluid. The patients were divided into mild group(n=35),moderate group(n=72),and severe group(n=21)according to the severity of their illness. The general clinical data and the levels of HBP,ADA and CHE in the cerebrospinal fluid of the grampositive bacteria group and the gramnegative bacteria group were compared. Analyze the differential diagnosis value of cerebrospinal fluid HBP,ADA,CHE levels to pathogenic bacteria of acute bacterial meningitis. Compare the levels of HBP,ADA and CHE in cerebrospinal fluid of patients with different severity of illness. Results There was no statistically significant difference between the general clinical data of the grampositive bacteria group and the gramnegative bacteria group(P>0.05). The cerebrospinal fluid HBP and ADA between the grampositive bacteria group and the gramnegative bacteria group were significantly different(t=5.924,5.650,P<0.05). There was no statistically significant difference in cerebrospinal fluid CHE between the grampositive bacteria group and the gramnegative bacteria group(t=0.587,P>0.05). The levels of HBP,ADA,and CHE in cerebrospinal fluid were used for differential diagnosis analysis of pathogenic bacteria of acute bacterial meningitis,and the best cutoff values were 213.82(ng/m L),2.50(U/L),151.63(U/L),and Youden index,respectively It is 0.42,0.40,0.17. Comparison of cerebrospinal fluid HBP,ADA and CHE in patients with different severity of illness,severe group > moderate group > mild group,the difference was statistically significant(F=17.332,17.332,13.994,P<0.05). Conclusion In the cerebrospinal fluid samples of patients with acute bacterial meningitis,the levels of HBP,CHE,and ADA were increase significantly,and their concentrations increase with the severity of the patient’s disease. Among them,HBP and ADA have certain significance in the identification of pathogens of acute bacterial meningitis.