血清及脑脊液S100蛋白和降钙素原诊断颅内感染的价值
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摘要
目的探讨血清及脑脊液S100蛋白、降钙素原(procalcitonin,PCT)在颅内感染诊断中的应用价值。方法颅内感染患者91例,其中细菌性脑炎患者43例(细菌性脑炎组),病毒性脑炎患者48例(病毒性脑炎组);同期38例癫痫患者为对照组。采用ELISA法检测3组入院48h内血清及脑脊液S100蛋白水平,电化学发光免疫法检测血清及脑脊液PCT水平;绘制ROC曲线分析血清及脑脊液S100蛋白、PCT鉴别诊断细菌性脑炎、病毒性脑炎的效能。结果病毒性脑炎组、细菌性脑炎组血清S100蛋白[(21.24±8.32)、(50.91±11.55)μg/L]、脑脊液S100蛋白[(14.60±6.45)、(40.38±8.05)μg/L]水平高于对照组[(0.24±0.10)、(2.16±0.72)μg/L],血清PCT[(0.38±0.12)、(0.89±0.22)μg/L]、脑脊液PCT[(0.19±0.09)、(0.76±0.20)μg/L]水平高于对照组[(0.23±0.09)、(0.09±0.03)μg/L](P<0.05),且细菌性脑炎组高于病毒性脑炎组(P<0.05);血清、脑脊液S100分别以36.19、28.51μg/L为最佳截断值,鉴别诊断细菌性脑炎与病毒性脑炎的AUC分别为0.972(95%CI:0.942～1.000,P<0.001)、0.994(95%CI:0.981～1.000,P<0.001),灵敏度分别为90.7%、97.7%,特异度分别为95.8%、97.9%;血清、脑脊液PCT分别以0.56、0.46μg/L为最佳截断值,鉴别诊断细菌性脑炎与病毒性脑炎的AUC分别为0.968(95%CI:0.924～1.000,P<0.001)、0.998(95%CI:0.993～1.000,P<0.001),灵敏度分别为93.0%、97.7%,特异度分别为95.8%、97.9%。结论颅内感染患者血清及脑脊液S100蛋白、PCT水平均升高,检测血清及脑脊液S100蛋白、PCT水平有助于细菌性脑炎与病毒性脑炎的鉴别诊断。
Objective To investigate the applications of S100 protein and procalcitonin(PCT)in serum and cerebrospinal fluid in the diagnosis of intracranial infection.Methods Ninety-one patients with intracranial infection were divided into 43 patients with bacterial encephalitis(bacterial encephalitis group)and 48 patients with viral encephalitis(viral encephalitis group)while another 38 patients with epilepsy were as controls(control group).The levels of S100 protein and PCT in serum and cerebrospinal fluid were detected by ELISA and electrochemiluminescence immunoassay respectively,and ROC was drawn to analyze the efficacies of S100 protein and PCT in serum and cerebrospinal fluid on differentiating bacterial encephalitis from viral encephalitis.Results The levels of S100protein(serum:(21.24±8.32),(50.91±11.55)μg/L;cerebrospinal fluid:(14.60±6.45),(40.38±8.05)μg/L)and PCT(serum:(0.38±0.12),(0.89±0.22)μg/L;cerebrospinal fluid:(0.19±0.09),(0.76±0.20)μg/L)in viral encephalitis group and bacterial encephalitis group were significantly higher than those in control group(S100protein:(0.24±0.10),(2.16±0.72)μg/L;PCT:(0.23±0.09),(0.09±0.03)μg/L)(P<0.05),and higher in bacterial encephalitis group than those in viral encephalitis group(P<0.05).When the optimal cut-offvalues of S100 protein in serum and cerebrospinal fluid were 36.19 and 28.51μg/L,respectively,the AUCs for bacterial encephalitis and viral encephalitis were 0.972(95%CI:0.942-1.000,P<0.001)and 0.994(95%CI:0.981-1.000,P<0.001),the sensitivities were 90.7% and 97.7%,and the specificities were 95.8% and 97.9%,respectively;when the optimal cut-off values of PCT in serum and cerebrospinal fluid were 0.56 and 0.46μg/L,the AUCs for bacterial encephalitis and viral encephalitis were 0.968(95%CI:0.924-1.000,P<0.001)and 0.998(95%CI:0.993-1.000,P<0.001),the sensitivities were 93.0% and 97.7%,and the sensitivities were 95.8% and 97.9%,respectively.Conclusion The levels of S100 protein and PCT in serum and cerebrospinal fluid increase in patients with intracranial infection,and the detection of them contributes to the differential diagnosis of bacterial encephalitis and viral encephalitis.
Objective To investigate the applications of S100 protein and procalcitonin(PCT)in serum and cerebrospinal fluid in the diagnosis of intracranial infection.Methods Ninety-one patients with intracranial infection were divided into 43 patients with bacterial encephalitis(bacterial encephalitis group)and 48 patients with viral encephalitis(viral encephalitis group)while another 38 patients with epilepsy were as controls(control group).The levels of S100 protein and PCT in serum and cerebrospinal fluid were detected by ELISA and electrochemiluminescence immunoassay respectively,and ROC was drawn to analyze the efficacies of S100 protein and PCT in serum and cerebrospinal fluid on differentiating bacterial encephalitis from viral encephalitis.Results The levels of S100protein(serum:(21.24±8.32),(50.91±11.55)μg/L;cerebrospinal fluid:(14.60±6.45),(40.38±8.05)μg/L)and PCT(serum:(0.38±0.12),(0.89±0.22)μg/L;cerebrospinal fluid:(0.19±0.09),(0.76±0.20)μg/L)in viral encephalitis group and bacterial encephalitis group were significantly higher than those in control group(S100protein:(0.24±0.10),(2.16±0.72)μg/L;PCT:(0.23±0.09),(0.09±0.03)μg/L)(P<0.05),and higher in bacterial encephalitis group than those in viral encephalitis group(P<0.05).When the optimal cut-offvalues of S100 protein in serum and cerebrospinal fluid were 36.19 and 28.51μg/L,respectively,the AUCs for bacterial encephalitis and viral encephalitis were 0.972(95%CI:0.942-1.000,P<0.001)and 0.994(95%CI:0.981-1.000,P<0.001),the sensitivities were 90.7% and 97.7%,and the specificities were 95.8% and 97.9%,respectively;when the optimal cut-off values of PCT in serum and cerebrospinal fluid were 0.56 and 0.46μg/L,the AUCs for bacterial encephalitis and viral encephalitis were 0.968(95%CI:0.924-1.000,P<0.001)and 0.998(95%CI:0.993-1.000,P<0.001),the sensitivities were 93.0% and 97.7%,and the sensitivities were 95.8% and 97.9%,respectively.Conclusion The levels of S100 protein and PCT in serum and cerebrospinal fluid increase in patients with intracranial infection,and the detection of them contributes to the differential diagnosis of bacterial encephalitis and viral encephalitis.
引文
[1]陈子龙,蒋广义,张大鹏,等.个体化治疗神经外科术后颅内感染25例临床分析[J].中国实用医刊,2013,40(14):73-75.
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[9]费爱华,潘曙明,刘鸣,等.降钙素原对脑损伤并多器官功能障碍综合征的预测价值[J].中华实用诊断与治疗杂志,2011,25(9):873-875.
[10]张燕搏,王旭,王飞燕,等.降钙素原在婴幼儿体外循环术后感染监测中价值[J].中华实用诊断与治疗杂志,2012,26(2):116-117.
[11]季方兵,刘少华.动态监测感染性休克患者液体复苏期血清降钙素原和C反应蛋白含量的变化及其与APACHEⅡ评分的关系[J].江苏医药,2013,39(20):2414-2416.
[12]何万涛,吴雪梅,赵云红,等.中枢神经系统感染患儿脑脊液及血中白细胞计数、降钙素原、C反应蛋白变化的相关性研究[J].中华医院感染学杂志,2016,26(18):4219-4221.
[13]王文徽,韩虹,杜丽君,等.中枢神经系统感染患儿脑脊液降钙素原测定的意义[J].山西医药杂志,2016,45(7):750-752.
[14]HASANI A.Diagnostic value of serum and cerebrospinal fluid procalcitonin in differentiation bacterial from aseptic meningitis[J].Am J Infect Dis,2010,6(4):56-62.
[15]SHEN H Y,GAO W,CHENG J J,et al.Direct comparison of the diagnostic accuracy between blood and cerebrospinal fluid procalcitonin levels in patients with meningitis[J].Clin Biochem,2015,48(16):1079-1082.
[2]张兰,谢怀珍,董传莉,等.血清降钙素原测定在新生儿细菌感染性疾病中的诊断价值[J].中华全科医学,2014,12(9):1419-1421.
[3]李季林,盛罗平,陈仁辉,等.S100B蛋白浓度的测定对颅脑损伤分型与判断预后的意义[J].中华全科医学,2013,11(10):1509-1510.
[4]吴江,贾建平,崔丽英.神经病学[M].北京:人民卫生出版社,2005:193-202.
[5]付慧,熊虹,康文清.血清S100蛋白及神经元烯醇化酶在新生儿胆红素脑病中表达及意义[J].中华实用诊断与治疗杂志,2018,32(7):676-677.
[6]SANDLER S J,FIGAJI A A,ADELSON P D.Clinical applications of biomarkers in pediatric brain injury[J].Childs Nerv Syst,2010,26(2):205-213.
[7]殷卫兵,严鸣光.病毒性脑炎患儿脑脊液和血清中NSE、MBP和S-100的变化及临床意义[J].中国卫生检验杂志,2015,25(22):3899-3902.
[8]梅道启.儿童病毒性脑炎脑脊液S100蛋白测定与神经元特异性烯醇化酶的动态变化分析[J].中国实用神经病学杂志,2017,20(1):52-54.
[9]费爱华,潘曙明,刘鸣,等.降钙素原对脑损伤并多器官功能障碍综合征的预测价值[J].中华实用诊断与治疗杂志,2011,25(9):873-875.
[10]张燕搏,王旭,王飞燕,等.降钙素原在婴幼儿体外循环术后感染监测中价值[J].中华实用诊断与治疗杂志,2012,26(2):116-117.
[11]季方兵,刘少华.动态监测感染性休克患者液体复苏期血清降钙素原和C反应蛋白含量的变化及其与APACHEⅡ评分的关系[J].江苏医药,2013,39(20):2414-2416.
[12]何万涛,吴雪梅,赵云红,等.中枢神经系统感染患儿脑脊液及血中白细胞计数、降钙素原、C反应蛋白变化的相关性研究[J].中华医院感染学杂志,2016,26(18):4219-4221.
[13]王文徽,韩虹,杜丽君,等.中枢神经系统感染患儿脑脊液降钙素原测定的意义[J].山西医药杂志,2016,45(7):750-752.
[14]HASANI A.Diagnostic value of serum and cerebrospinal fluid procalcitonin in differentiation bacterial from aseptic meningitis[J].Am J Infect Dis,2010,6(4):56-62.
[15]SHEN H Y,GAO W,CHENG J J,et al.Direct comparison of the diagnostic accuracy between blood and cerebrospinal fluid procalcitonin levels in patients with meningitis[J].Clin Biochem,2015,48(16):1079-1082.