IL-18、IL-23和sRAGE在早产儿脑膜炎诊断中的应用

Application of IL-18,IL-23 and sRAGE in diagnosis of preterm infants with meningitis

目的探讨白细胞介素18(IL-18)、白细胞介素23(IL-23)和可溶性受体晚期糖基化终产物(sRAGE)在诊断早产儿细菌性脑膜炎中的临床价值。方法将96例早产儿分为脑脊液(CSF)细菌培养阳性脑膜炎组(26例)、脑脊液细菌培养阴性脑膜炎组(40例)和非脑膜炎组(30例);测量各组患儿脑脊液中的IL-18、IL-23和sRAGE水平,比较感染和未感染早产儿上述表达的差异,并采用ROC曲线分析单个标志物和标志物联合诊断的灵敏度和特异度。结果脑膜炎早产儿CSF中IL-18、IL-23和sRAGE水平高于非脑膜炎组(P<0.001)。在单个标志物中,IL-23对于细菌脑膜炎具有最高的诊断准确性,IL-23曲线下面积(AUC)0.977。3种标记物联用的AUC为0.981。结论IL-23单独及与IL-18和sRAGE组合方式鉴定细菌性脑膜炎精确度高,可帮助临床医生诊断早产儿细菌性脑膜炎和决策是否延长抗生素治疗。

Objective To investigate the clinical value of interleukin 18(IL-18),interleukin 23(IL-23)and soluble receptor for advanced glycation-end products(sRAGE)in the diagnosis of bacterial meningitis in premature infants.Methods Ninety-six premature infants were divided into cerebrospinal fluid(CSF)bacterial culture-positive meningitis group(26cases),cerebrospinal fluid bacterial culture-negative meningitis group(40cases)and non-meningitis group(30cases).The levels of IL-18,IL-23 and sRAGE in the cerebrospinal fluid of the preterms in each group were measured,and the differences of the above expressions were compared between infected and uninfected premature infants,and the sensitivity and specificity of single marker and marker combined diagnosis were analyzed by ROC curve.Results The levels of IL-18,IL-23 and sRAGE in CSF of preterm infants with meningitis were higher than those in non-meningitis group(P<0.001).Among the single markers,IL-23 had the highest diagnostic accuracy for bacterial meningitis with IL-23 area under the curve(AUC)0.977.The AUC for the combination of the 3markers was 0.981.Conclusion IL-23 alone or in combination with IL-18 and sRAGE has high accuracy in identifying bacterial meningitis,which can help clinicians diagnose bacterial meningitis in premature infants and decide whether to prolong antibiotic therapy.