血清降钙素原与细菌性脑膜炎患儿病情程度及预后的关系

Serum procalcitonin levels: Relationship to severity of disease and prognosis in pediatric bacterial meningitis

目的 研究血清降钙素原 (PCT)水平与细菌性脑膜炎患儿病情程度及预后的关系。方法 把 82例急性脑膜炎患儿分为细菌性及病毒性脑膜炎两大类。根据病情程度把患儿分为无败血症组、轻度败血症组、严重败血症组及败血症休克组。采用化学发光免疫分析法分别检测入院时和入院 72h后的血清PCT水平 ,同时检测C -反应蛋白 (CRP)。及外周血白细胞。结果 ( 1)细菌性脑膜炎患儿的血清PCT水平明显高于病毒性脑膜炎组 [( 5 2 1± 10 70 )ng/m1,( 0 2 7± 0 13)ng/m1,P <0 0 0 1]。 ( 2 )细菌性脑膜炎合并严重败血症及败血症休克者血清PCT水平明显高于无败血症及轻度败血症者 [( 2 1 14± 16 94 )ng/ml,( 1 2 3± 0 81)ng/ml,P <0 0 0 1)。 ( 3)细菌性脑膜炎治疗有效者PCT明显下降 [( 2 4 5± 2 5 3)ng/ml,( 0 87± 0 2 5 )ng/ml,P <0 0 5 ],而治疗无效者PCT不降 [( 19 78± 18 33)ng/ml,( 19 5 6± 18 97)ng/m1,P >0 0 5 ]。 ( 4 )细菌性脑膜炎存活者的PCT水平明显低于死亡者 [( 1 4 3± 1 2 4 )ng/ml,( 2 5 0 3± 16 ,79)ng/ml,P <0 0 0 1)。结论 血清PCT水平的高低可以反映细菌性脑膜炎的轻重 ,其动态变化可以判断治疗效果和预后。

Objective To investigate the relationship between serum procalgitonin (PCT)levels and prognosis in children with bacterial meningitis.Methods 82 children patients (25)with bacterial meningitis and 57 with viral meningitis) were included in this prospective study.The diagnosis of meningitis was based on compatible clinical features and cerebrospinal fluid findings. PCT serum levels were measured with a specific immunoluminometric assay at admission and after 72 h.Results ①Patients with bacterial meningitis had significantly higher serum PCT than those of viral meningitis[(5 21± 10 70)ng/ml vs (0 27±0 13)ng/ml, P <0 001]. ②The PCT levels of patients with severe sepsis or septic shock were significantly higher than those who had no sepsis or mild sepsis [(21 14±16 94)ng/ml vs(1 23±0 81)ng/ml, P <0 001]. ③The temperature of twenty bacterial meningitis patients decreased with antibiotic treatment 72 h later. PCT levels had decreased from (2 45±2 53)ng/ml to (0 87 ± 0 25)ng/ml in ten of those patients( P <0 05). The temperature of 5 bacterial meningitis patients did not decrease after antibiotic treatment. The PCT levels did not change [(19 78 4± 18 33)ng/ml vs (19 56 4± 18 97)ng/ml, P >0 05]. ④The PCT levels differed significantly between those who survived and those who died [(1 43 ± 1 24)ng/ml vs(25 034± 16 79)ng/ml, P <0 001].Conclusion Serum PCT is related to the severity of disease in children with bacterial meningitis. A fall in PCT after treatment may have favorable prognostic significance.