重症病毒性脑炎患儿脑脊液sIL-2R和CGRP及sVCAM-1表达水平及其预后影响因素

The expression levels of sIL⁃2R,CGRP,sVCAM⁃1 in cerebrospinal fluid of children with severe viral encephalitis and their prognostic factors

目的检测重症病毒性脑炎患儿脑脊液可溶性白介素2受体(sIL-2R)、降钙素基因相关肽(CGRP)、可溶性血管细胞间粘附分子-1(sVCAM-1)表达水平,分析其对患儿预后的预测价值。方法收集2020年6月-2023年1月南阳南石医院收治的136例重症病毒性脑炎患儿临床资料,所有患儿出院后均随访3个月,根据随访期间患儿预后情况将其分为预后不良组(n=43)和预后良好组(n=93)。分析重症病毒性脑炎患儿不良预后发生的因素,采用多因素logistic回归分析重症病毒性脑炎患儿预后不良的危险因素,比较两组脑脊液sIL-2R、CGRP、sVCAM-1表达水平,采用受试者工作特征(ROC)曲线分析脑脊液sIL-2R、CGRP、sVCAM-1对重症病毒性脑炎患儿的预测价值。结果多因素logistic回归分析结果显示,发热持续时间≥5 d、持续惊厥、应激性高血糖、磁共振成像(MRI)异常均为重症病毒性脑炎患儿预后不良的独立危险因素(OR=3.501、1.960、2.643、2.743,P均<0.05)。预后不良组脑脊液sIL-2R、CGRP、sVCAM-1表达水平均高于预后良好组,差异均有统计学意义(t=7.214、6.779、3.558,P均<0.05)。脑脊液sIL-2R、CGRP、sVCAM-1联合预测重症病毒性脑炎患儿预后的曲线下面积及敏感度均高于三者单独检测,CGRP敏感度高于sIL-2R、sVCAM-1,sIL-2R、sVCAM-1特异度高于CGRP及联合检测,差异均有统计学意义(P均<0.05)。结论重症病毒性脑炎患儿预后不良的危险因素包括发热持续时间≥5 d、持续惊厥、应激性高血糖、MRI异常,不同预后重症病毒性脑炎患儿脑脊液sIL-2R、CGRP、sVCAM-1表达水平存在明显差异,同时三者联合对患儿不良预后的预测价值较好。

Objective To analyze the expression levels of soluble interleukin⁃2 receptor(sIL⁃2R),calcitonin gene⁃related peptide(CGRP)and soluble vascular intercellular adhesion molecule⁃1(sVCAM⁃1)in cerebrospinal fluid of children with severe viral encephalitis and the prognostic factors.Methods Clinical data of 136 children with severe viral encephalitis admitted to the Nanyang South Stone Hospital from June 2020 to January 2023 were retrospectively collected.All the children were followed up for 3 months after discharge,and were divided into the poor prognosis group(43 cases)and the good prognosis group(93 cases)according to the prognosis during the follow⁃up.The single factor of poor prognosis in children with severe viral encephalitis was analyzed.The risk factors of poor prognosis in children with severe viral encephalitis were analyzed by multivariate logistic regression.The expression levels of sIL⁃2R,CGRP and sVCAM⁃1 in cerebrospinal fluid of the two groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of cerebrospinal fluid sIL⁃2R,CGRP and sVCAM⁃1 in children with severe viral encephalitis.Results Multivariate logistic regression analysis showed that fever duration≥5 d,persistent convulsion,stress hyperglycemia and abnormal magnetic resonance imaging(MRI)were independent risk factors for poor prognosis in children with severe viral encephalitis(OR=3.501,1.960,2.643,2.743;all P<0.05).The expression levels of sIL⁃2R,CGRP and sVCAM⁃1 in cerebrospinal fluid of the poor prognosis group were higher than those of the good prognosis group,the differences were statistically significant(t=7.214,6.779,3.558;all P<0.05).The area under the curve value and sensitivity of cerebrospinal fluid combined with sIL⁃2R,CGRP and sVCAM⁃1 to predict the prognosis of children with severe viral encephalitis were higher than those of the three tests alone,the sensitivity of CGRP was higher than that of sIL⁃2R and sVCAM⁃1,the specificity of sIL⁃2R and sVCAM⁃1 was higher than that of CGRP and CGRP combined,the differences were statistically significant(all P<0.05).Conclusions The risk factors for poor prognosis in children with severe viral encephalitis include fever duration≥5 d,persistent convulsion,stress hyperglycemia,and abnormal MRI.There were significant differences in the expression levels of sIL⁃2R,CGRP,and sVCAM⁃1 in cerebrospinal fluid of children with severe viral encephalitis with different prognosis,and the combination of the three factors had better predictive value for poor prognosis.