血清sST2在早期筛查细菌性脑膜炎中的应用价值

Application value of serum soluble ST2 in early screening of bacterial meningitis

目的为感染性脑膜炎寻找有价值的血液炎症标志物联合脑脊液生化指标检测,用于细菌性脑膜炎(BM)的早期筛查及鉴别诊断。方法选取2020年8月至2021年7月在武汉大学中南医院神经外科住院治疗的感染性脑膜炎患者163例,包括病毒性脑膜炎(VM组)、BM(BM组)和真菌性脑膜炎(FM组),另选取32例体检健康人群和66例疑似脑膜炎患者作为对照组和SM组。检测患者的血清C反应蛋白(CRP)、淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)、降钙素原(PCT)、可溶性生长刺激表达基因2蛋白(sST2)、全血白细胞计数(WBC)和红细胞沉降率,以及脑脊液中蛋白、氯化物、葡萄糖和乳酸等指标情况。结果VM、BM、FM组和SM组入院时血清IL-6、SAA、sST2水平均明显高于对照组(P<0.05);BM组sST2水平高于SM组(P<0.05);BM组PCT阳性率(PCT>0.05 ng/mL)明显高于VM和FM组(P<0.05);SM组WBC高于对照组(P<0.05);BM、SM组红细胞沉降率高于对照组(P<0.05)。血清sST2联合脑脊液葡萄糖两项指标联合检测用于鉴别BM与疑似脑膜炎的曲线下面积为0.862,特异度和灵敏度分别为94%和70%。此外,BM患者血清sST2水平与脑脊液葡萄糖水平呈负相关(P<0.05)。结论血清sST2联合脑脊液葡萄糖可作为从疑似脑膜炎患者中早期筛查BM的候选指标。IL-33/ST2信号通路可能参与了BM的炎症反应机制,靶向sST2可能为BM治疗提供新思路。

Objective To search the valuable blood inflammatory markers combined with cerebrospinal fluid biochemical markers for the early screening and differential diagnosis of bacterial meningitis(BM)patients.Methods A total of 163 patients with infectious meningitis hospitalized in the Department of Neurosurgery,Zhongnan Hospital of Wuhan University from August 2020 to July 2021 were selected,including viral meningitis(VM group),BM group and fungal meningitis(FM group)were enrolled in this study.Another 32 healthy subjects and 66 suspected meningitis patients were taken as control and SM group,respectively.Serum C-reactive protein(CRP),serum amyloid A(SAA),Interleukin-6(IL-6),procalcitonin(PCT)and soluble suppression of tumorigenicity-2(sST2),white blood cell counts(WBC)and erythrocyte sedimentation rate were tested,combined with cerebrospinal fluid indicators,including protein,chlorine,glucose and lactate.Results The serum levels of IL-6,SAA and sST2 in VM,BM,FM and SM groups on admission were significantly higher than that in the control group(P<0.05).Serum sST2 level in BM group was obviously higher than that in the SM group(P<0.05).The positive rate of PCT(PCT>0.05 ng/mL)in BM group was significantly higher than that in VM and FM group(P<0.05).WBC in SM group was higher than that in the control group(P<0.05).Erythrocyte sedimentation rates in BM and SM group were higher than that in the control group(P<0.05).The area under the curve of the combined detection of serum sST2 and cerebrospinal fluid glucose for distinguishing BM and suspected meningitis was 0.862,with specificity and sensitivity of 94%and 70%,respectively.Additionally,the serum sST2 level in BM patients was negatively correlated with the cerebrospinal fluid glucose level(P<0.05).Conclusion Serum sST2 combined with cerebrospinal fluid glucose may be used as the candidate markers for early screening of BM from the suspected meningitis patients.IL-33/ST2 signaling pathway might be involved in the inflammatory response machanism of BM,and targeting sST2 may provide a novel idea for the treatment of BM.