体液免疫指标、炎性反应标志物联合预测病毒性脑炎患儿预后价值分析

Combination of humoral immunity and inflammatory markers predicts the prognostic value in children with viral encephalitis

目的探讨体液免疫指标联合炎性反应标志物对病毒性脑炎患儿预后的预测价值。方法回顾性选取2020年12月至2022年6月在淮北矿工总医院治疗的80例病毒性脑炎患儿(研究组)和同期健康体检儿童80例(对照组)为研究对象,比较两组血清体液免疫指标[免疫球蛋白A(IgA)、IgG、IgM]、炎性反应标志物[C反应蛋白(CRP)、降钙素原(PCT)]水平。研究组随访6个月,53例患儿预后良好(预后良好组),27例患儿预后不良(预后不良组),比较两组上述指标水平,采用Spearman/Pearson检验分析体液免疫指标与炎性反应标志物的相关性及各指标与病情程度的关系,采用受试者工作特征(ROC)曲线分析上述指标对患儿预后的预测价值。结果研究组血清IgA、IgG、IgM水平低于对照组,CRP、PCT水平高于对照组[(0.81±0.20)g/L比(1.79±0.46)g/L、(8.02±1.48)g/L比(9.88±1.57)g/L、(0.87±0.22)g/L比(2.06±0.54)g/L、(7.32±2.41)mg/L比(1.03±0.34)mg/L、(1.55±0.33)μg/L比(0.74±0.21)μg/L],差异有统计学意义(P<0.05)。病毒性脑炎患儿预后不良组血清CRP水平高于预后良好组,血清IgA、IgG、IgM水平低于预后良好组[(8.77±2.25)mg/L比(6.58±1.54)mg/L、(0.63±0.21)g/L比(0.90±0.30)g/L、(6.25±1.30)g/L比(8.89±2.78)g/L、(0.72±0.18)g/L比(0.94±0.26)g/L],差异有统计学意义(P<0.05);Spearman检验结果显示,血清CRP水平与病情程度呈正相关(r=0.775,P<0.01),IgA、IgG、IgM水平与病情程度呈负相关(r=-0.624、-0.608、-0.619,P<0.01)。Pearson检验结果显示,血清IgA、IgG、IgM与CRP呈负相关(r=-0.707、-0.783、-0.739,P<0.05)。ROC曲线分析结果显示,血清CRP、IgA、IgG、IgM联合预测病毒性脑炎患儿预后的曲线下面积为0.922(95%CI 0.841~0.970)。结论病毒性脑炎患儿体液免疫指标和炎性反应标志物对病情和预后评估有重要作用,血清CRP、IgA、IgG、IgM联合检测可作为患儿早期预测预后的重要途径。

Objective To investigate the predictive value of humoral immune indicators combined with inflammatory markers on the prognosis of children with viral encephalitis.Methods Eighty children with viral encephalitis in Huaibei Miners General Hospital from December 2020 to June 2022 were retrospectively selected as the study group,and another 80 children with healthy physical examination at the same period were selected as the control group.The levels of serumhumoral immune indexes immunoglobulin A(IgA),IgG,IgM and inflammatory markers C-reactive protein(CRP),procalcitonin(PCT)were compared between the two groups.The study group was followed up for 6 months and divided into the good prognosis group(53 children)and the poor prognosis group(27 children).The levels of the above indicators were compared between the two groups and the children with different degrees of disease,and the correlation between humoral immune indicators and inflammatory markers and the relationship between each indicator and the degree of disease were analyzed by Spearman/Pearson test,and the predictive prognostic value of each indicator was evaluated by receiver operating characteristic(ROC)curve.Results The levels serum IgA,IgG and IgM in the study group were lower than those in the control group,and the levels CRP and PCT were higher than those in the control group:(0.81±0.20)g/L vs.(1.79±0.46)g/L,(8.02±1.48)g/L vs.(9.88±1.57)g/L,(0.87±0.22)g/L vs.(2.06±0.54)g/L,(7.32±2.41)mg/L vs.(1.03±0.34)mg/L,(1.55±0.33)μg/L vs.(0.74±0.21)μg/L,there were statistical differences(P<0.05).The level CRP in the poor prognosis group was higher than that in the good prognosis group,the levels serum IgA,IgG and IgM were lower than those in the good prognosis group:(8.77±2.25)mg/L vs.(6.58±1.54)mg/L,(0.63±0.21)g/L vs.(0.90±0.30)g/L,(6.25±1.30)g/L vs.(8.89±2.78)g/L,(0.72±0.18)g/L vs.(0.94±0.26)g/L,there were statistical differences(P<0.05).The results of Spearman test showed that serum CRP was positively correlated with the degree of disease(r=0.775,P<0.01),serum IgA,IgG and IgM were negatively correlated with the degree of disease(r=-0.624,-0.608,-0.619,P<0.01).The results of Pearson test showed that serum IgA,IgG and IgM were negatively correlated with CRP(r=-0.707,-0.783,-0.739,P<0.05).The results of ROC curve showed that the area under the curve(AUC)of serum CRP,IgA,IgG and IgM jointly for predicting prognosis was 0.922(95%CI:0.841-0.970).Conclusions Children with viral encephalitis have humoral immune disorders,which are closely linked to the inflammatory response and have an important impact on the disease and prognosis.Combined serum CRP,IgA,IgG and IgM testing can be an important way to predict prognosis at an early stage.