脑脊液/血清PCT比值与小儿病毒性脑炎病情、预后转归的关系

Relationship Between Cerebrospinal Fluid/Serum PCT Ratio and the Condition and Prognosis of Viral Encephalitis in Children

目的探讨脑脊液/血清降钙素原(procalcitonin,PCT)比值与小儿病毒性脑炎(viral encephalitis,VE)病情、预后转归的关系。方法将2020-09/2022-01月作者医院收治的117例VE患儿纳入本研究,根据格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分将患儿分为非危重组(GCS评分>8分,n=72)和危重组(GCS评分≤8分,n=45)。采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测患儿脑脊液及血清PCT水平,并计算二者比值。入院即刻连续随访1年,根据儿童格拉斯哥预后量表(Glasgow outcome scale,GOS)评估患儿预后情况,分为预后良好组(GOS评级4~5级,n=86)和预后不良组(GOS评级≤3级,n=31)。采用Pearson相关分析探讨VE患儿脑脊液/血清PCT比值与GCS评分的关系,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析脑脊液/血清PCT比值对VE患儿预后的预测价值;采用单因素及多因素Logistic回归分析探讨影响VE患儿预后的相关因素。结果危重组患儿脑脊液、血清PCT水平及二者比值均高于非危重组患儿(P<0.05)。VE患儿脑脊液PCT、血清PCT及二者比值与GCS评分均呈负相关(r=-0.473、-0.416、-0.629,P均<0.05)。预后不良组患儿脑脊液、血清PCT水平及二者比值均高于预后良好组患儿(P<0.05)。脑脊液PCT、血清PCT、脑脊液/血清PCT比值预测VE患儿预后的曲线下面积(area under the curve,AUC)(95%CI)分别为0.823(0.772~0.874)、0.772(0.721~0.823)、0.905(0.854~0.956),截点值分别为11.46 ng/ml、3.76 ng/ml、2.89 ng/ml,特异度分别为65.12%、56.98%、87.21%,灵敏度分别为90.32%、90.32%、87.10%。多因素Logistic回归分析显示,意识障碍(OR=2.284,95%CI:1.568~3.328)、入院GCS评分≤8分(OR=2.102,95%CI:1.463~3.021)、脑脊液/血清PCT比值≥2.89(OR=3.219,95%CI:2.003~5.172)是VE患儿预后不良的独立危险因素(P<0.05)。结论脑脊液/血清PCT比值升高与VE患儿的病情危重及不良预后密切相关,且脑脊液/血清PCT比值在VE患儿预后的评估中具有较高的临床预测价值,有望作为临床诊治VE的有效生物标志物。

Objective To explore the relationship between cerebrospinal fluid/serum procalcitonin(PCT)ratio and the condition and prognosis of viral encephalitis(VE)in children.Methods A total of 117 children with VE admitted to author′s hospital from September 2020 to January 2022 were selected as the subjects,according to the Glasgow coma scale(GCS)score,the patients were divided into non-critical group(GCS score8,n=72)and critical group(GCS score≤8,n=45).The levels of PCT in cerebrospinal fluid and serum were measured by enzyme-linked immunosorbent assay(ELISA)and the ratio of the two was calculated.Follow-up for 1 year immediately after admission,the outcomes of the children were assessed according to the Glasgow outcome scale(GOS)for children,and the patients were divided into two groups:the group with good prognosis(GOS rating 4-5,n=86)and the group with poor prognosis(GOS rating≤3,n=31).The relationship between cerebrospinal fluid/serum PCT ratio and GCS score in children with VE was investigated by Pearson correlation analysis,the prognostic value of cerebrospinal fluid/serum PCT ratio in children with VE was analyzed by receiver operating characteristic(ROC)curve;the related factors affecting the prognosis of children with VE were explored by univariate and multivariate Logistic regression analysis.Results The PCT levels of cerebrospinal fluid,serum and their ratio in the critical group were higher than those in the non-critical group(P<0.05).Cerebrospinal fluid PCT,serum PCT and their ratio were negatively correlated with GCS scores in VE children(r=-0.473,-0.416,-0.629,all P<0.05).The levels of cerebrospinal fluid,serum PCT and their ratio in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The area under the curve(AUC)(95%CI)of cerebrospinal fluid PCT,serum PCT and cerebrospinal fluid/serum PCT ratio in predicting the prognosis of VE children were 0.823(0.772-0.874),0.772(0.721-0.823)and 0.905(0.854-0.956)respectively,the cut-off values were 11.46 ng/ml,3.76 ng/ml and 2.89 ng/ml,the specificity were 65.12%,56.98%and 87.21%,and the sensitivity were 90.32%,90.32%and 87.10%respectively.Multivariate Logistic regression analysis showed that the disorder of consciousness(OR=2.284,95%CI:1.568-3.328),admission GCS score≤8(OR=2.102,95%CI:1.463-3.021)and cerebrospinal fluid/serum PCT ratio≥2.89(OR=3.219,95%CI:2.003-5.172)were independent risk factors for poor prognosis in children with VE(P<0.05).Conclusion The increase of cerebrospinal fluid/serum PCT ratio is closely related to the severity and poor prognosis of children with VE,and the cerebrospinal fluid/serum PCT ratio has high clinical predictive value in the evaluation of the prognosis of children with VE,which is expected to be an effective biomarker for clinical diagnosis and treatment of VE.