摘要
目的探讨脑脊液和血清中肿瘤坏死因子相关激活蛋白(CD-40L)、白细胞介素-17(IL-17)在成人脑膜炎患者中的鉴别诊断价值。方法选择2018年6月-2020年10月在安阳市人民医院收治的细菌性脑膜炎患者38例、病毒性脑膜炎患者51例为研究对象,另选同期住院患者(疑似为中枢神经系统感染,但行CT或MRI检查、脑脊液检查等排除中枢神经系统感染,同时排除神经系统损伤或病变等疾病)45例作为对照组。比较各组患者脑脊液和血清中CD-40L、IL-17表达水平;采用ROC曲线分析脑脊液和血清CD-40L、IL-17对细菌性脑膜炎的诊断价值。结果与对照组比较,病毒性脑膜炎和细菌性脑膜炎患者脑脊液与血清中CD-40L、IL-17表达水平均明显升高,差异有统计学意义(P<0.05);与病毒性脑膜炎患者比较,细菌性脑膜炎患者脑脊液和血清中CD-40L、IL-17表达水平明显升高,差异有统计学意义(P<0.05)。治疗1周后,对照组、病毒性脑膜炎组、细菌性脑膜炎组脑脊液和血清中CD-40L、IL-17表达水平差异无统计学意义(P>0.05)。脑脊液CD-40L与血清中IL-17对细菌性脑膜炎的诊断效能最高,其中脑脊液CD-40L预测细菌性脑膜炎曲线下面积为0.898,截断值为0.88 ng/mL,敏感度为84.21%,特异性为90.20%;血清IL-17预测细菌性脑膜炎曲线下面积为0.897,截断值为12.90 pg/mL,敏感度为86.84%,特异度为82.35%。结论脑膜炎患者脑脊液和血清中CD-40L、IL-17水平显著升高,可作为鉴别细菌性脑膜炎、病毒性脑膜炎的标志物,对患者的治疗、预后改善有一定临床价值。
Objective To investigate the differential diagnostic value of CD40 ligand(CD-40L)and interleukin-17(IL-17)in cerebrospinal fluid and serum of patients with meningitis.Methods Thirty-eight cases of bacterial meningitis and fiftyone cases of viral meningitis admitted to Anyang People.s Hospital from June 2018 to October 2020 were selected as the research objects and forty-five cases of hospitalized patients in the same period as the control group.The expression levels of CD-40L and IL-17 in the cerebrospinal fluid and serum of each group of patients were compared.The diagnostic values of CD-40L and IL-17 in cerebrospinal fluid and serum in patients with bacterial meningitis were analyzed by ROC curve.Results Compared with those in the control group,the expression levels of CD-40L and IL-17 in cerebrospinal fluid and serum of viral meningitis and bacterial meningitis were significantly increased(P<0.05);compared with those in viral meningitis group,the expression levels of CD-40L and IL-17 in cerebrospinal fluid and serum of patients with bacterial meningitis were significantly higher(P<0.05);after one week of treatment,there was no significant difference in the expression levels of CD-40L and IL-17 in cerebrospinal fluid and serum among the control group,patients with viral meningitis and patients with bacterial meningitis(P>0.05).CD-40L in cerebrospinal fluid and IL-17 in serum had the highest diagnostic efficiency for bacterial meningitis.The area under curve of CD-40L in cerebrospinal fluid predicting bacterial meningitis was 0.898 and the cutoff value was 0.88 ng/mL,with sensitivity of 84.21%,and specificity of 90.20%.The area under the curve of IL-17 in serum predicting bacterial meningitis was 0.897 and the cut-off value was 12.90 pg/mL,with sensitivity of 86.84%,and specificity of 82.35%.Conclusion The levels of CD-40L and IL-17 in cerebrospinal fluid and serum of children with meningitis were significantly increased;it could be used as markers to identify bacterial meningitis and viral meningitis,and had certain value in the treatment and prognosis improvement of patients.
作者
郭予东
张赟
郭艳平
GUO Yu-dong;ZHANG Yun;GUO Yan-ping(Department of Pain,the People’s Hospital of Anyang City,Anyang,Henan,455000,China)
出处
《热带医学杂志》
CAS
2021年第4期495-498,F0003,共5页
Journal of Tropical Medicine
基金
河南省医学科技攻关计划联合共建项目(LHGJ20191269)。
作者简介
郭予东(1981-),女,本科,主治医师,从事神经内科工作;通信作者:郭艳平,E-mail:78199533@qq.com。
