血清CRP LACT PCT表达在化脓性脑膜炎诊断中的价值

The value of serum CRP, LACT and PCT expression in the diagnosis of bacterial meningitis

目的 探讨血清C-反应蛋白、乳酸、降钙素原表达在化脓性脑膜炎诊断中的价值。方法 将84例颅内感染患儿根据病原学检查结果分为化脓性脑膜炎组47例与病毒性脑膜炎组37例,将40例同期热性惊厥或免疫性脑炎患儿设为对照组。比较3组血清C-反应蛋白、乳酸、降钙素原水平。将化脓性脑膜炎组患儿根据病情严重程度分为重症组与普通组,比较重症组与普通组血清C-反应蛋白、乳酸、降钙素原水平,格拉斯哥昏迷评分法评分、儿童早期预警评分。分析血清C-反应蛋白、乳酸、降钙素原水平与化脓性脑膜炎患儿格拉斯哥昏迷评分法评分、儿童早期预警评分的相关性。绘制受试者工作特征曲线,评价血清C-反应蛋白、乳酸、降钙素原表达对化脓性脑膜炎的诊断价值。结果 化脓性脑膜炎组血清C-反应蛋白、乳酸、降钙素原水平均显著高于病毒性脑膜炎组及对照组(P<0.05);病毒性脑膜炎组血清C-反应蛋白水平显著高于对照组(P<0.05),血清乳酸、降钙素原水平与对照组比较差异无统计学意义(P>0.05)。化脓性脑膜炎重症组血清C-反应蛋白、乳酸、降钙素原水平及儿童早期预警评分均显著高于普通组(P<0.01),格拉斯哥昏迷评分法评分显著低于普通组(P<0.01)。化脓性脑膜炎患儿血清C-反应蛋白、乳酸、降钙素原水平均与格拉斯哥昏迷评分呈显著负相关(P<0.05或0.01),与儿童早期预警评分呈显著正相关(P<0.01)。C-反应蛋白、乳酸、降钙素原三者联合检测的曲线下面积为0.997,灵敏度、特异度为0.979、1.000。结论 化脓性脑膜炎患儿血清C-反应蛋白、乳酸、降钙素原水平明显上升,且与病情严重程度密切相关,检测血清C-反应蛋白、乳酸、降钙素原有助于化脓性脑膜炎早期诊断,值得临床推广应用。

Objective To investigate the diagnostic value of serum C-reactive protein(CRP),lactic acid(LACT)and procalcitonin(PCT)expression in children with bacterial meningitis(BM).Methods A total of 84 children with intracranial infection were divided into BM group(47 cases)and viral meningitis(VE)group(37 cases)according to the results of etiological examination,and another 40 children with febrile convulsion or immune encephalitis during the same period were set as the control group.The levels of serum CRP,LACT and PCT in the three groups were compared.The children in BM group were divided into severe group and normal group according to the severity of the disease.Serum CRP,LACT and PCT levels,Glasgow coma scale(GCS)score and pediatric early warning score(PEWS)were compared between the severe group and the normal group.The correlation between serum CRP,LACT and PCT levels and GCS score and PEWS score of BM children was analyzed.Receiver operating characteristic(ROC)was drawn to evaluate the value of serum CRP,LACT and PCT in the diagnosis of BM.Results The levels of serum CRP,LACT and PCT in BM group were significantly higher than those in VE group and control group ( P <0.05). The level of serum CRP in VE group was significantly higher than that in control group ( P <0.05), but there were no statistically significant differences in the levels of serum LACT[FL]and PCT compared with those in control group ( P >0.05). The levels of serum CRP, LACT and PCT and score of PEWS in BM severe group were significantly higher than those in normal group ( P <0.01), while the GCS score was significantly lower than that in normal group ( P <0.01). The levels of serum CRP, LACT and PCT in patients with BM were negatively correlated with GCS score ( P <0.05 or 0.01) and positively correlated with PEWS score ( P <0.01). The area under the curve (AUC) of the combined detection of CRP, LACT and PCT was 0.997, and the sensitivity and specificity were 0.979 and 1.000. Conclusions The levels of serum CRP, LACT and PCT in children with BM are significantly increased, and are closely related to the severity of the disease. The detection of serum CRP, LACT and PCT is helpful for the early diagnosis of BM, and is worthy of clinical application.