单纯疱疹病毒感染后脑脊液S100B、Cys-C、MMP-9水平对自身免疫性脑炎的预测价值

Predictive value of S100B, Cys-C and MMP-9 levels in cerebrospinal fluid afterherpes simplex virus infection for autoimmune encephalitis

目的:探究单纯疱疹病毒(HSV)感染后脑脊液(CSF)中S100B、Cys-C、MMP-9水平对自身免疫性脑炎(AE)的预测价值。方法:选取2016年1月至2021年3月河北中石油中心医院收治的200例HSV感染患者为研究对象,根据是否继发AE分为研究组(继发AE,35例)和对照组(未继发AE,165例)。多因素Logistic回归分析HSV感染患者继发AE的独立影响因素。Spearman法分析脑脊液中Cys-C、MMP-9与S100B水平的相关性。受试者工作特征(ROC)曲线分析S100B、Cys-C、MMP-9对AE的预测价值。构建风险预测模型并进行评价。结果:多因素Logistic回归分析显示,MRI异常、脑脊液S100B、MMP-9升高、EEG异常是HSV感染患者继发AE的独立危险因素,脑脊液Cys-C是其保护因素(P<0.05)。Spearman分析显示,HSV感染患者Cys-C浓度与S100B水平呈负相关(r=-0.83,P<0.05),MMP-9浓度与S100B水平呈正相关(r=0.88,P<0.05)。构建的联合预测因子pre1诊断HSV患者继发AE的AUC明显大于S100B、Cys-C、MMP-9单独预测的AUC(0.876 vs 0.827、0.787、0.750)。构建的风险预测模型具有良好的区分度和一致性。结论:脑脊液中S100B、Cys-C、MMP-9水平均可对HSV感染患者诱发AE的可能性进行有效预测,且三项指标联合预测价值最大,其次是S100B蛋白、Cys-C、MMP-9。

Objective:To investigate predictive value of S100B,Cys-C and MMP-9 levels in cerebrospinal fluid(CSF)after herpes simplex virus(HSV)infection in inducing autoimmune encephalitis(AE).Methods:A total of 200 patients with HSV infection admitted to Hebei Petrochina Central Hospital from January 2016 to March 2021 were selected as research objects,and divided into study group(secondary AE,35 cases)and control group(no secondary AE,165 cases)according to whether developed secondary AE.Multivariate Logistic regression was used to analyze independent influencing factors of secondary AE in patients with HSV infection.Spearman was used to analyze correlation between Cys-C,MMP-9 and S100B levels in CSF.Receiver operating characteristic(ROC)curve was used to analyze predictive value of S100B,Cys-C and MMP-9 for AE.Risk prediction model was constructed and evaluated.Results:Multivariate Logistic regression analysis showed that MRI abnormality,CSF S100B,MMP-9 elevation and EEG abnormality were independent risk factors for secondary AE in patients with HSV infection,and CSF Cys-C was protective factor(P<0.05).Spear-man showed that there was a negative correlation between Cys-C concentration and S100B level in HSV patients(r=-0.83,P<0.05),and a positive correlation between MMP-9 concentration and S100B level(r=0.88,P<0.05).AUC of constructed combined prediction pre1 was significantly higher than that of S100B,Cys-C and MMP-9 alone(0.876 vs 0.827,0.787,0.750).Risk prediction model has good distinction and consistency.Conclusion:S100B,Cys-C and MMP-9 levels in CSF can effectively predict possibility of AE induced by HSV infection,and combined prediction value of three indexes is the highest,followed by S100B protein,Cys-C and MMP-9.