补体C3、C4和免疫球蛋白在儿童细菌性脑膜炎中的动态变化及意义

Dynamic changes and significance of complement C3,C4,and immunoglobulin in children with bacterial meningitis

目的 探讨补体C3、C4和免疫球蛋白(Ig)在儿童细菌性脑膜炎(BM)中的动态变化及意义。方法 选取开封市儿童医院2020年2月至2023年2月收治的131例儿童BM患儿为研究对象,根据治疗1个月后哥斯拉预后评分(GOS)将患儿分为预后不良组(39例,GOS评分≤4分)和预后良好组(92例,GOS评分=5分)。比较两组(治疗前、治疗3 d后、治疗7 d后)血清补体C3、C4、IgA、IgG、IgM水平,分析(治疗3 d后、治疗7 d后)血清各指标水平与预后不良的相关性,ROC分析(治疗3 d后、治疗7 d后)血清C3、C4、IgA、IgG、IgM水平联合检测对BM患儿预后不良的预测价值,分析各指标不同水平患儿出现预后不良的危险度。结果 治疗后3 d、7 d后预后不良组血清C3、C4、IgA、IgG、IgM水平高于预后良好组,且各指标水平与预后不良均呈正相关(P<0.05);治疗3 d、7 d后血清C3、C4、IgA、IgG、IgM水平联合预测预后不良的AUC分别为0.704、0.834,且各指标高水平患儿预后不良危险度分别是低水平的2.255、2.510、3.696、4.704、4.518倍和2.678、3.458、4.158、5.359、4.704倍(P<0.05)。结论 血清C3、C4、IgA、IgG、IgM水平与儿童BM预后不良情况呈正相关,其联合检测可作为临床评估BM预后的有效参考依据。

Objective To investigate the dynamic changes and significance of complement C3,C4,and immunoglobulin(Ig)in children with bacterial meningitis(BM).Methods Totally 131 children with BM admitted to our hospital from February 2020 to February 2023 were selected as research objects.According to Godzilla prognosis score(GOS)after one month of treatment,the children were divided into poor prognosis group(39 cases,GOS score≤4 points)and good prognosis group(92 cases,GOS score=5 points).The serum complement levels of C3,C4,IgA,IgG and IgM were compared between the two groups(before treatment,3 days after treatment and 7 days after treatment),and the correlation between serum indicators and poor prognosis was analyzed(3 days after treatment and 7 days after treatment).ROC analysis(3 days after treatment,7 days after treatment)of the combined detection of serum C3,C4,IgA,IgG,IgM levels in the prediction of poor prognosis in BM children,analysis of the risk of poor prognosis in children with different levels of each indicator.Results The levels of C3,C4,IgA,IgG and IgM in the poor prognosis group were higher than those in the good prognosis group at 3 and 7 days after treatment,and the levels of all indexes were positively correlated with the poor prognosis(P<0.05).The AUCs of C3,C4,IgA,IgG and IgM combined to predict poor prognosis after 3 and 7 days of treatment were 0.704 and 0.834,respectively.Moreover,the risk of por prognosis in children with high levels of each index was 2.255,2.510,3.696,4.704,4.518 times and 2.678,3.458,4.158,5.359,4.704 times of those with low levels(P<0.05).Conclusion Serum levels of C3,C4,IgA,IgG and IgM are positively correlated with poor prognosis of children with BM,and their combined detection can be used as an effective reference for clinical evaluation of BM prognosis.