HBP、陷窝蛋白-1及PCT在鉴别诊断脑膜炎患儿疾病类型及预后中的价值

Value of HBP,Caveolin-1 and PCT in the differential diagnosis of disease types and prognosis in children with meningitis

目的探讨脑脊液中肝素结合蛋白(HBP)、陷窝蛋白-1(Caveolin-1)、降钙素原(PCT)在鉴别诊断脑膜炎患儿疾病类型及预后判断中的价值。方法采用回顾性研究方法,选取2018年5月至2021年1月荆州市第二人民医院收治的脑膜炎患儿108例,根据感染病原体类型分为细菌组56例、病毒组52例。对比两组患儿脑脊液中HBP、Caveolin-1、PCT的水平。细菌感染性脑膜炎患儿中,分为重症组33例,普通组23例;预后不良组15例,预后良好组41例。病毒性脑膜炎患儿中,分为重症组25例,普通组27例;预后不良组15例,预后良好组37例。根据病情、预后结局分析各组患儿脑脊液中HBP、Caveolin-1、PCT的水平。采用受试者工作特征(ROC)曲线分析3项指标在鉴别诊断脑膜炎患儿疾病类型及预后中的应用价值。结果细菌组的脑脊液中HBP、Caveolin-1、PCT值均高于病毒组患儿,差异均有统计学意义(P<0.05)。脑脊液中HBP诊断细菌性脑膜炎、病毒性脑膜炎的敏感度为88.67%,特异度为85.17%,曲线下面积(AUC)值为0.934;PCT诊断细菌性脑膜炎、病毒性脑膜炎的敏感度为76.44%,特异度为90.20%,AUC值为0.867;Caveolin-1诊断细菌性脑膜炎、病毒性脑膜炎的敏感度为70.33%,特异度为80.54%,AUC值为0.809。细菌性脑膜炎患儿与病毒性脑膜炎患儿中,重症组脑脊液中HBP、Caveolin-1、PCT水平均高于普通组,差异均有统计学意义(P<0.05)。细菌性脑膜炎患儿与病毒性脑膜炎患儿中,预后不良组脑脊液中HBP、Caveolin-1、PCT水平均高于预后良好组,差异均有统计学意义(P<0.05)。脑脊液中HBP、Caveolin-1、PCT水平预测细菌性脑膜炎患儿预后的AUC值分别为0.820、0.681、0.773;脑脊液中HBP、Caveolin-1、PCT水平预测病毒性脑膜炎患儿预后的AUC值分别为0.766、0.708、0.795。结论脑脊液中HBP、Caveolin-1、PCT水平检测对于鉴别脑膜炎感染病原体类型,判断患儿病情及对预后进行评估均具有一定的临床价值。

Objective To explore the value of heparin-binding protein(HBP),caveolin-1(Caveolin-1)and procalcitonin(PCT)in cerebrospinal fluid in the differential diagnosis of disease types and prognosis of children with meningitis.Methods A retrospective research method was used to select 108 children with meningitis who were admitted to Jingzhou Second People's Hospital from January 2018 to January 2021.According to the type of infectious pathogen,they were divided into 56 cases in the bacterial group and 52 cases in the viral group.The levels of HBP,Caveolin-1,and PCT in the cerebrospinal fluid of the two groups of children were compared.Among children with bacterial meningitis,there were divided into 33 cases in the severe group and 23 cases in the general group;15 cases in the group with poor prognosis and 41 cases in the group with good prognosis.Among children with viral meningitis,there were divided into 25 cases in the severe group and 27 cases in the general group;there were 15 cases in the group with poor prognosis and 37 cases in the group with good prognosis.The levels of HBP,Caveolin-1,and PCT in the cerebrospinal fluid of each group of children were analyzed based on their condition and prognosis.The receiver operating characteristic(ROC)curve was used to analyze the three indicators in the differentiation application value in diagnosing disease types and prognosis of children with meningitis.Results The values of HBP,Caveolin-1 and PCT in the cerebrospinal fluid of the bacterial group were higher than those of the viral group,and the differences were statistically significant(P<0.05).The sensitivity and specificity of HBP in cerebrospinal fluid for diagnosing bacterial and viral meningitis were 88.67%,85.17%,and the area under curve(AUC)value was 0.934;the sensitivity and specificity of PCT for diagnosing bacterial and viral meningitis were 76.44%,90.20%,and the AUC value was 0.867;the sensitivity and specificity of Caveolin-1 in diagnosing bacterial and viral meningitis were 70.33%,80.54%,and the AUC value was 0.809.In children with bacterial meningitis and viral meningitis,the levels of HBP,Caveolin-1,and PCT in the cerebrospinal fluid of the severe group were higher than those of the ordinary group,the differences were statistically significant(P<0.05).In children with bacterial meningitis and viral meningitis,the poor prognosis group of HBP,Caveolin-1,PCT in the cerebrospinal fluid were higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).The AUC values of HBP,Caveolin-1,and PCT levels in cerebrospinal fluid for predicting the prognosis of children with bacterial meningitis were 0.820,0.681,and 0.773,respectively;the AUC values of HBP,Caveolin-1,and PCT levels in cerebrospinal fluid for predicting prognosis in children with viral meningitis were 0.766,0.708,and 0.795,respectively.Conclusion The detection of HBP,Caveolin-1 and PCT levels in cerebrospinal fluid has certain clinical value for identifying the type of meningitis infection pathogen,judging the condition of children and evaluating the prognosis.