脑脊液HBP和外周血PCT、hs-CRP在小儿化脓性脑膜炎中的诊断价值

The application value of HBP in cerebrospinal fluid,PCT and hs-CRP in peripheral blood for diagnosis of purulent meningitis in children

目的探讨脑脊液(CSF)肝素结合蛋白(HBP)和外周血降钙素原(PCT)、超敏C反应蛋白(hs-CRP)在小儿化脓性脑膜炎(PM)诊断中的应用价值。方法收集2019年2月至2020年2月于昆明市儿童医院住院的中枢感染患儿60例,根据感染的病原体类型分为化脓性脑膜炎(PM)组(n=30)(其中CSF培养阳性6例,分别为大肠埃希菌3例,肺炎链球菌2例,产单核李斯特菌1例),病毒性脑炎(VM)组(n=30),选择30例同期经检查证实无中枢神经系统损伤患儿作为对照组,测定并分析三组患儿CSF中HBP和外周血PCT、hs-CRP水平,采用受试者工作特征(ROC)曲线分析各指标单一和联合鉴别PM和VM的诊断效能,并计算ROC下面积(AUC)。结果PM组CSF中HBP、外周血PCT及hs-CRP水平显著高于VM组及对照组,差异具有统计学意义(P<0.05);PM组CSF培养阳性各菌株三个检测指标水平比较差异无统计学意义(P>0.05)。CSF中HBP及外周血PCT、hs-CRP、HBP+PCT+hs-CRP的AUC分别为0.950、0.877、0.864、0.959。当HBP、PCT、hs-CRP cutoff值分别为5.93 ng/mL、0.62 ng/mL、6.70 mg/L时,敏感度分别为91.30%、73.90%、78.30%;特异度分别为98.30%、91.40%、75.90%;阳性预测值分别为95.00%、77.10%、58.12%;阴性预测值分别为97.01%、91.02%、88.05%。结论CSF中HBP是一种在PM与VM鉴别诊断中具有较高价值的指标,联合外周血PCT及hs-CRP能提高对PM的诊断价值。

Objective To explore the application value of cerebrospinal fluid(CSF)heparin-binding protein(HBP),procalcitonin(PCT)and High-sensitivity C-reactive protein(hs-CRP)in peripheral blood(PB)for purulent meningitis(PM)in children.Methods A total of 60 children definited diagnosis as Central nervous infection in Kunming Children’s Hospital from February 2019 to February 2020 were collected.According to the type of pathogen infected,they were divided into the purulent meningitis(PM)group(n=30),Among them,6 cases were positive for CSF culture,including 3 cases of Escherichia coli,2 cases of Streptococcus pneumoniae and 1 case of Listeria monocytogenes.and viral meningitis(VM)group(n=30),30 children who with no central nervous system injury confirmed by examination in the same period were selected as the control group,measure and analyze the levels of HBP in CSF,PCT and hs-CRP in Peripheral blood.the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of each index single and combined to distinguish PM and VM,and the area under ROC(AUC)was calculated.Results The level of HBP in CSF and PCT,hs-CRP in Peripheral blood of PM group were significantly higher than those of VM group and control group,and the difference was statistically significant(P<0.05);There was no significant difference among the three indexes of CSF culture positive strains in PM group(P>0.05).The AUC of HBP in CSF and PCT,hs-CRP in peripheral blood,HBP+PCT+hs-CRP in CSF are 0.950,0.877,0.864,0.959 respectively.When the cutoff values of HBP,PCT,hs-CRP are 5.93 ng/m L,0.62 ng/m L,6.70 mg/L,respectively,the sensitivity is 91.30%,73.90%,78.30%;the specificity is 98.30%,91.40%,75.90%,respectively;positive predictive values are 95.00%,77.10%,58.12%;negative predictive values are 97.01%,91.02%,88.05%.Conclusion HBP in CSF is an indicator of high value in the differential diagnosis of PM and VM.The combination of PCT and hs-CRP in peripheral blood can improve the diagnostic value of PM.