肝素结合蛋白、白介素-1β、丙二醛与新生儿化脓性脑膜炎病情严重程度与转归的关系

Relationships of HBP,IL-1βand MDA in cerebrospinal fluid with severity and prognosis of neonatal purulent meningitis

目的探讨脑脊液肝素结合蛋白(HBP)、白介素-1β(IL-1β)、丙二醛(MDA)与新生儿化脓性脑膜炎病情严重程度与病情转归的关系及意义。方法选取2020年1月至2021年12月昆明市儿童医院收治的107例新生儿化脓性脑膜炎患儿为研究对象,其中35例为轻度,41例为重度,31例为危急重症,根据病情转归分为不良组、良好组,比较不同病情严重程度和不同病情转归患儿脑脊液HBP、IL-1β、MDA水平,采用Spearman分析脑脊液HBP、IL-1β、MDA与病情严重程度关系,采用受试者工作特征曲线(ROC)、曲线下面积(AUC)分析脑脊液HBP、IL-1β、MDA预测病情转归价值。结果不同病情程度脑脊液HBP、IL-1β、MDA水平不完全相同,两两比较发现危急重症组水平最高,重度组次之,轻度组最低,差异有统计学意义(F值分别为64.013、188.867、148.795,P<0.05);Spearman分析结果显示脑脊液HBP、IL-1β、MDA与病情程度均正相关(r值分别为0.863、0.832、0.824,P<0.05);预后不良组脑脊液HBP、IL-1β、MDA水平均高于良好组,差异有统计学意义(t值分别为8.933、11.222、6.252,P<0.05);ROC曲线结果显示HBP、IL-1β、MDA预测病情转归的AUC分别为0.748、0.733、0.794,三者联合预测的AUC为0.942,大于单独指标(P<0.05)。结论脑脊液HBP、IL-1β、MDA与新生儿化脓性脑膜炎病情严重程度正相关,并与患儿病情转归密切相关,联合检测时可作为评估病情程度及预测不良病情转归危险度的一个可靠方案,为临床干预提供重要参考信息。

Objective To investigate relationships of heparin-binding protein(HBP),interleukin-1β(IL-1β)and malondialdehyde(MDA)in cerebrospinal fluid(CSF)with severity and prognosis of neonatal purulent meningitis.Methods 107 neonates with purulent meningitis(including 35 mild cases,41 severe cases and 31 critical cases)who admitted to our hospital from January 2020 to December 2021were selected as study subjects,and they were divided into poor prognosis group and good prognosis group according to disease outcome.The levels of HBP,IL-1β,and MDA in CSF of the neonates with different severity and different disease prognosis were compared between the two groups.Spearman correlation analysis was used to analyze relationships of HBP,IL-1βand MDA with severity of the disease.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze predictive values of HBP,IL-1βand MDA in CSF for prognosis of the disease.Results There were significant differences in levels of HBP,IL-1βand MDA in CSF among different severity groups,and pairwise comparison revealed that their levels were the highest in the critical group,followed by the severe group and were the lowest in the mild group(F=64.013,188.867 and 148.795 respectively,all P<0.05).Spearman correlation analysis showed that HBP,IL-1βand MDA in CSF were positively correlated with degree of the disease(r=0.863,0.832 and 0.824 respectively,all P<0.05).The levels of HBP,IL-1βand MDA in CSF were higher in the poor prognosis group than those in the good prognosis group,and the differences were statistically significant(t=8.933,11.222 and 6.252 respectively,all P<0.05).The ROC curve showed that the AUCs of HBP,IL-1βand MDA in CSF for predicting prognosis of the disease were 0.748,0.733 and 0.794 respectively,and the AUC of the combination of the three indexes for predictingprognosis of the disease was 0.942,which was greater than that of the each individual index(P<0.05).Conclusion HBP,IL-1β,and MDA in CSF are positively correlated with severity of neonatal purulent meningitis and closely correlated with prognosis of the disease,and the combined detection can be used as a reliable way to assess severity of the disease and to predict risk of adverse disease prognosis,which provides important reference information for clinical intervention.