摘要
目的探讨脑脊液肝素结合蛋白(HBP)检测在小儿化脓性脑膜炎(PM)诊断和预后预测中的价值。方法采取回顾性研究方法,选取2018年8月至2019年1月湖南省儿童医院收治的化脓性脑膜炎患儿(PM组)76例,病毒性脑炎患儿(VE组)55例,另选择同期40例脑脊液白细胞计数正常的非感染性疾病患儿作为对照组。PM组患儿按照出院时的格拉斯哥临床结局评分分为预后良好亚组(65例)和预后不良亚组(11例)。测定PM组入院第1天和第7天、VE组和对照组入院第1天的脑脊液HBP、白细胞计数(WBC)、中性粒细胞百分比(N%)、葡萄糖(Glu)、总蛋白(TP)、乳酸脱氢酶(LDH)及血清降钙素原(PCT)水平。利用非参数检验分析各组间检测指标的差异,Spearman相关检验分析HBP与其他各指标的相关性,建立受试者工作特征曲线(receiver operating characteristic curve,ROC)评价各检测指标对化脓性脑膜炎的诊断价值及预后预测能力。结果入院第1天PM组、VE组和对照组之间脑脊液HBP[63.09(18.10~272.19)ng/mL、5.90(5.90~6.40)ng/mL和5.90(5.90~5.90)ng/mL]、WBC[365.00(20.00~1285.00)×10^6/L、21.00(8.00~30.00)×10^6/L和13.50(7.25~21.00)×10^6/L]、N%[0.65(0.50~0.79)、0.19(0.10~0.25)和0.21(0.15~0.27)]、Glu[1.97(1.07~3.08)mmol/L、2.89(2.66~3.42)mmol/L和3.04(2.68~3.42)mmol/L]、TP[1.43(0.63~1.88)g/L、0.23(0.16~0.32)g/L和0.13(0.10~0.31)g/L]、LDH[152.00(46.50~461.50)IU/L、16.00(13.20~22.00)IU/L和16.00(10.25~19.75)IU/L]及血清PCT[1.35(0.19~9.33)ng/ml、0.06(0.03~0.11)ng/ml和0.08(0.05~0.14)ng/ml]水平差异均有统计学意义(HHBP=138.62、HWBC=69.72、HN%=10^6.67、HGlu=34.08、HTP=68.00、HLDH=85.11、HPCT=79.20,P<0.001);各检测指标用于诊断化脓性脑膜炎的曲线下面积最大为HBP(AUC=0.997),HBP最佳诊断界值(11.84 ng/mL)时敏感度、特异度、阳性预示值、阴性预示值分别为98.70%、97.90%、97.40%、98.94%。PM患儿预后良好亚组入院第7天与第1天比较,脑脊液HBP、WBC、N%、TP、LDH及血清PCT水平均降低,差异有统计学意义(P<0.05),脑脊液Glu入院第7天与第1天比较差异无统计学意义(P>0.05);预后不良亚组入院第7天与第1天各指标比较差异均无统计学意义(P>0.05)。入院第1天各指标预测PM患儿预后不良,差异均无统计学意义(P>0.05);入院第7天各指标用于预测PM患儿预后不良,差异均有统计学意义(P<0.05),AUC最大为HBP(0.976),HBP最佳预测界值(128.84 ng/mL)时敏感度、特异度、阳性预示值、阴性预示值分别为100.0%、93.8%、73.3%、100.0%。脑脊液HBP与WBC、N%、TP、LDH及血清PCT水平均呈正相关(rWBC=0.670、rN%=0.802、rTP=0.562、rLDH=0.524、rPCT=0.436,P<0.001),与脑脊液Glu水平呈负相关(r=-0.469,P<0.001)。结论脑脊液HBP检测在小儿化脓性脑膜炎诊断与预后预测中具有一定的临床价值。
Objective To explore the clinical value of determining heparin-binding protein(HBP)of cerebrospinal fluid(CSF)in the diagnosis and prognostic prediction in children with purulent meningitis(PM).Methods 76 children with PM,55 children with viral encephalitis(VE)and 40 control children with non-infectious diseases,all admitted to Hunan Children′Hospital from August 2018 to January 2019,were enrolled in this retrospective study.Children with PM were divided into favorable prognosis group and poor prognosis group according to the Glasgow Outcome Scale on discharge.CSF HBP,white blood cell count(WBC),percentage of neutrophilic granulocyte(N%),glucose(Glu),total protein(TP),lactic dehydrogenase(LDH)and serum procalcitonin(PCT)were analyzed on the first day of admission(DAY1)in PM group,VE group and control group,and on the seventh day of admission(DAY7)in PM group.Nonparametric tests were used to detect the differences of the laboratory indexes and Spearman rank correlation test was utilized to analyze the correlation between HBP and other markers.Receiver operating characteristic curves(ROC curves)were established to evaluate the values of the detection indexes in the diagnosis and prognosis of PM.Results The differences of CSF HBP[63.09(18.10-272.19)ng/mL,5.90(5.90-6.40)ng/mL and 5.90(5.90-5.90)ng/mL],WBC[365.00(20.00-1285.00)×10^6/L,21.00(8.00-30.00)×10^6/L and 13.50(7.25-21.00)×10^6/L],N%[0.65(0.50-0.79),0.19(0.10-0.25)and 0.21(0.15-0.27)],Glu[1.97(1.07-3.08)mmol/L,2.89(2.66-3.42)mmol/L and 3.04(2.68-3.42)mmol/L],TP[1.43(0.63-1.88)g/L,0.23(0.16-0.32)g/L and 0.13(0.10-0.31)g/L],LDH[152.00(46.50-461.50)IU/L,16.00(13.20-22.00)IU/L and 16.00(10.25-19.75)IU/L]and serum PCT[1.35(0.19-9.33)ng/mL,0.06(0.03-0.11)ng/mL and 0.08(0.05-0.14)ng/mL]levels on DAY1 were statistically significant among PM group,VE group and control group(HHBP=138.62,HWBC=69.72,HN%=10^6.67,HGlu=34.08,HTP=68.00,HLDH=85.11,HPCT=79.20,P<0.001).HBP had the largest area under curve(AUC=0.997)for the diagnosis of PM,and had excellent sensitivity,specificity,positive predictive value,negative predictive value(98.70%,97.90%,97.40%,98.94%,respectively)at the optimal cut-off value(11.84 ng/mL).Compared with DAY1,CSF HBP,WBC,N%,TP,LDH and serum PCT levels on DAY7 were statistically lower in favorable prognosis group(P<0.05).The differences for all the indexes between DAY1 and DAY7 in poor prognosis group were not statistically significant,however.It was not significant for all the indexes on DAY1 to predict poor prognosis(P>0.05).But the indexes on DAY7 for predicting poor prognosis were significant(P<0.05)and HBP still had the largest AUC(0.976)for predicting the poor prognosis with good sensitivity,specificity,positive predictive value,negative predictive value(100.0%,93.8%,76.3%,100.0%,respectively)at the optimal cut-off value(128.84 ng/mL).CSF HBP was positively correlated to CSF WBC,N%,TP,LDH,serum PCT level(rWBC=0.670,rN%=0.802,rTP=0.562,rLDH=0.524,rPCT=0.436,P<0.001)and negatively correlated to CSF Glu level(r=-0.469,P<0.001).Conclusions CSF HBP is valuable in the diagnosis and prognostic prediction in children with purulent meningitis.
作者
黄彩芝
张洁
莫丽亚
Huang Caizhi;Zhang Jie;Mo Liya(Center of Clinical Laboratory Medicine,Hunan Children′s Hospital,Changsha 410007,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2019年第11期955-961,共7页
Chinese Journal of Laboratory Medicine
关键词
肝素结合蛋白
抗微生物阳离子肽类
化脓性脑膜炎
脑脊液
儿童
Heparin-binding protein
Antimicrobial cationic peptides
Purulent meningitis
Cerebrospinal fluid
Child
