摘要
目的研究急性化脓性脑膜炎(PM)患儿脑脊液分泌型CD163(sCD163)、α2巨球蛋白(A2M)的水平及两者与患儿不良预后的关系。方法收集2020年1月—2022年1月海南医学院附属海南医院/海南省人民医院儿科诊治PM患儿114例为PM组,根据中枢神经系统功能障碍的程度,分为重症亚组(n=38)和普通亚组(n=76),依据出院6个月时格拉斯哥(Glasgow)预后评分,分为预后良好亚组(n=84)和预后不良亚组(n=30)。以同期诊治的病毒性脑膜炎(VM)患儿60例为VM组,中枢神经系统非感染疾病患儿60例为对照组。采用酶联免疫吸附试验检测脑脊液sCD163、A2M水平;Logistic回归分析PM预后影响因素;受试者工作特征曲线分析脑脊液sCD163、A2M对PM预后的评估价值。结果脑脊液sCD163、A2M水平比较,PM组>VM组>对照组(F/P=1522.470/<0.001,1487.801/<0.001);重症亚组PM患儿脑脊液sCD163、A2M水平高于普通亚组(t/P=17.900/<0.001,14.896/<0.001);预后不良亚组PM患儿休克比例及脑脊液WBC、CRP、sCD163、A2M均明显高于预后良好亚组(χ^(2)/t/P=4.878/0.027,7.612/<0.001,16.100/<0.001,9.522/<0.001,20.939/<0.001);休克和脑脊液WBC、CRP、sCD163、A2M升高是PM患儿预后不良的危险因素[OR((95%CI)=1.237(1.054~1.453),1.172(1.104~1.355),1.202(1.208~1.406),1.210(1.057~1.386),1.156(1.040~1.285)];脑脊液sCD163、A2M二者联合诊断PM的曲线下面积(AUC)为0.929,大于脑脊液sCD163、A2M各自单项的0.880、0.841(Z=4.572、5.358,P均<0.001)。结论PM患儿脑脊液中sCD163、A2M水平异常升高,两者与患儿病情程度有关,两者联合对评估PM患儿不良预后具有较高的预测价值。
Objective To study the level of cerebrospinal fluid(CSF)secretory CD163(sCD163),αalpha 2 macroglobulin(A2M)in children with acute purulent meningitis(PM)and correlation with poor prognosis.Methods To investigate the levels of sCD163 and A2M in cerebrospinal fluid of children with acute purulent meningitis(PM)and their relationship with poor prognosis.A total of 114 children with PM who were diagnosed and treated in the Department of Pediatrics,Hainan Hospital Affiliated to Hainan Medical College/Hainan Provincial People's Hospital from January 2020 to January 2022 were enrolled as the PM group.According to the degree of central nervous system dysfunction,they were divided into severe subgroup(n=38)and general subgroup(n=76).According to the Glasgow outcome Scale at 6 months after discharge,the patients were divided into good prognosis subgroup(n=84)and poor prognosis subgroup(n=30).A total of 60 children with viral meningitis(VM)who were diagnosed and treated during the same period were enrolled as VM group,and 60 children with non-infectious diseases of the central nervous system were enrolled as control group.Enzyme-linked immunosorbent assay was used to measure the levels of sCD163 and A2M in cerebrospinal fluid.Logistic regression was used to analyze the prognostic factors of PM.Receiver operating characteristic curve was used to analyze the value of cerebrospinal fluid sCD163 and A2M in evaluating the prognosis of PM.Results The levels of sCD163 and A2M in cerebrospinal fluid of PM group were higher than those of VM group and control group(F/P=1522.470/<0.001,1487.801/<0.001).The children in the severe subgroup had significantly higher levels of sCD163 and A2M in cerebrospinal fluid than those in the general subgroup(t/P=17.900/<0.001,14.896/<0.001).The proportion of children with shock and the levels of WBC,CRP,sCD163,and A2M in cerebrospinal fluid in the poor prognosis subgroup were significantly higher than those in the good prognosis subgroup(t/P=4.878/0.027,7.612/<0.001,16.100/<0.001,9.522/<0.001,20.93
作者
陈远禄
万科成
钟广会
周潮艾
刘英杰
冯小伟
Chen Yuanlu;Wan Kecheng;Zhong Guanghui;Zhou Chaoai;Liu Yingjie;Feng Xiaowei(Department of Pediatrics,Hainan Medical College Affiliated Hainan Hospital/Hainan Provincial People's Hospital,Haikou 570311,China)
出处
《疑难病杂志》
CAS
2024年第7期828-833,共6页
Chinese Journal of Difficult and Complicated Cases
基金
海南省卫生健康行业科研项目(21A200170)。
