PCT、IGF-1及HBP与新生儿GBS感染所致化脓性脑膜炎的关系

Clinical significance of PCT,IGF⁃1 and HBP in serum and cerebrospinal fluid in neonates with purulent meningitis induced by GBS infection

目的 探讨新生儿B族链球菌(GBS)感染所致化脓性脑膜炎(PM)血清和脑脊液中降钙素原(PCT)、胰岛素样生长因子(IGF)-1及肝素结合蛋白(HBP)的表达水平及临床意义。方法 选取2019年5月至2023年5月衡水市人民医院收治的44例因CBS感染的PM新生儿作为PM组,并选取同期疑似PM的新生儿44例作为对照组,比较两组及PM组不同病情程度患儿、不同预后患儿血清和脑脊液中降钙素原(PCT)、胰岛素样生长因子(IGF)-1及肝素结合蛋白(HBP)表达水平;治疗结束后,利用ROC分析血清及脑脊液PCT、IGF-1及HBP水平单项及多项联合预测新生儿GBS所致PM患儿的预后价值。结果PM组血清PCT、HBP水平均高于对照组,IGF-1水平低于对照组,脑脊液PCT、HBP、IGF-1水平均高于对照组,差异均有统计学意义(P<0.05)。重症组血清PCT、HBP水平均高于轻症组,IGF-1水平低于轻症组,脑脊液PCT、IGF-1、HBP水平均高于轻症组,差异均有统计学意义(P<0.05)。44例PM患儿预后不良发生率为27.27%,预后不良组血清PCT、HBP水平均高于预后良好组,IGF-1水平低于预后良好组,脑脊液PCT、IGF-1、HBP水平均高于预后良好组,差异均有统计学意义(P<0.05)。ROC曲线分析显示,血清及脑脊液PCT、IGF-1、HBP水平单项均具有预测GBS感染所致PM患儿的预后价值(P<0.05)。血清指标联合预测与脑脊液指标联合预测AUC值比较差异无统计学意义(P>0.05)。结论 血清和脑脊液中PCT、IGF-1、HBP表达水平变化与GBS所感PM新生儿病情程度及预后相关,可对病情程度及预后进行评估和预测。

Objective To explore the expression levels and clinical significance of procalcitonin(PCT),insulin-like growth factor(IGF)-1 and heparin-binding protein(HBP)in serum and cerebrospinal fluid in neonates with purulent meningitis(PM)induced by group B streptococcus(GBS)infection.Methods A to-tal of 44 neonates with PM induced by GBS infection and 44 neonates with suspected PM in the hospital were en-rolled as the PM group and the control group between May 2019 and May 2023,respectively.The expression levels of PCT,IGF-1 and HBP in serum and cerebrospinal fluid were detected and compared between the two groups,and differences in neonates with varying disease severity were observed.After treatment,the prognosis of PM neonates was evaluated.The prognostic value of the three indexes was analyzed using ROC curves.Results The levels of serum PCT and HBP in the PM group were higher than those in the control group,while IGF-1 was lower than in the control group,and levels of PCT,HBP and IGF-1 in cerebrospinal fluid were higher in the PM group compared to the control group(P<0.05).The levels of serum PCT and HBP in neonates with severe PM were higher than those with mild PM,while IGF-1 was lower than that with mild PM,and lev-els of PCT,IGF-1 and HBP in cerebrospinal fluid were all higher than those with mild PM(P<0.05).Among the 44 PM neonates,the incidence of poor prognosis was 27.27%.The levels of serum PCT and HBP in neo-nates with poor prognosis were higher than those with good prognosis,IGF-1 was lower than that with good prognosis,and levels of PCT,IGF-1 and HBP in cerebrospinal fluid were all higher than those with good prog-nosis(P<0.05).ROC curve analysis showed that PCT,IGF-1 and HBP in both serum and cerebrospinal fluid were prognostic indicators(P<0.05).There was no significant difference in AUC between the combined serum indicators and combined cerebrospinal fluid indicators(P>0.05).Conclusion The changes of PCT,IGF-1 and HBP in serum and cerebrospinal fluid are correlated with disease severity and prognosis.These changes can help evaluate and predict the severity and prognosis of neonates with PM induced by GBS infection.