TBM患者脑脊液IL-33 sCD163治疗前后变化及与预后的关系

Changes of cerebrospinal fluid IL-33 and s CD163 in TBM patients before and after treatment and their relationship with prognosis

目的分析结核性脑膜炎(TBM)患者脑脊液白细胞介素-33(IL-33)、可溶性CD163(sCD163)治疗前后变化情况,并探究二者与预后的关系。方法选取2020-08—2022-02三二〇一医院TBM患者93例,入院后均积极治疗。比较治疗前及治疗1周脑脊液IL-33、sCD163水平,统计患者预后情况,比较不同预后TBM患者的相关资料。采用Logistic回归分析TBM患者预后的影响因素,采用受试者工作特征(ROC)曲线分析脑脊液IL-33及sCD163评估TBM患者预后的价值,采用决策曲线进一步分析脑脊液IL-33及s CD163评估TBM患者预后的价值。结果TBM患者治疗1周脑脊液IL-33、sCD163水平低于治疗前(P<0.05);存在脑积水、脑梗死、脑膜刺激征、治疗1周脑脊液IL-33及sCD163高水平表达是TBM患者病情恶化的独立危险因素(P<0.05);ROC分析显示,IL-33联合sCD163评估TBM患者预后的AUC值0.870[95%CI(0.784~0.931),P<0.001]最大;决策曲线分析显示,除风险阈值为0.32~0.39外联合检测对TBM患者预后评估的获益优于IL-33、sCD163。结论经治疗后TBM患者脑脊液IL-33、sCD163水平明显降低,若治疗后脑脊液IL-33、sCD163仍处于较高水平则提示患者预后较差,二者可作为评估TBM患者预后的辅助性指标,具有一定临床应用价值。

Objective To analyze the changes of cerebrospinal fluid interleukin-33(IL-33)and soluble CD163(s CD163)in patients with tuberculous meningitis(TBM)before and after treatment,and to explore their relationship with prognosis.Methods A total of 93 patients with TBM in our hospital from August 2020 to February2022 were selected and they were actively treated after admission.The levels of IL-33 and sCD163 in cerebrospinal fluid before and after treatment were compared.The prognosis of patients was counted,and the related data of TBM patients with different prognosis were compared.Logistic regression was used to analyze the prognostic factors of TBM patients.Receiver operating characteristic(ROC)curve was used to analyze the value of IL-33 and sCD163 in cerebrospinal fluid to evaluate the prognosis of TBM patients.Decision curve was used to further analyze the value of IL-33 and s CD163 in cerebrospinal fluid in evaluating the prognosis of TBM patients.Results The levels of IL-33 and sCD163 in the cerebrospinal fluid of TBM patients after one week of treatment were lower than those before treatment(P<0.05).The presence of hydrocephalus,cerebral infarction,meningeal irritation sign,and high expression of IL-33 and sCD163 in cerebrospinal fluid after 1 week of treatment were independent risk factors for the deterioration of TBM patients(P<0.05).ROC analysis showed that the AUC value of IL-33combined with s CD163 in evaluating the prognosis of TBM patients was the largest at 0.870[95%CI(0.784-0.931),P<0.001].Decision curve analysis showed that,except for the risk threshold of 0.32-0.39,the benefit of combined detection in evaluating the prognosis of TBM patients was better than that of IL-33 and sCD163.Conclusion After treatment,the levels of IL-33 and sCD163 in the cerebrospinal fluid of TBM patients were significantly decreased.If the levels of IL-33 and sCD163 in cerebrospinal fluid are still high after treatment,it indicates that the prognosis of the patients is poor.Both of them can be used as auxiliary indicators to evaluate the prognosis of TBM patients,and they have certain clinical application value.