细菌性脑膜炎病原学特征及脑脊液TNF-α与MMP-9和可溶性B7-H3表达的临床意义
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摘要
目的探讨细菌性脑膜炎病原学分布及脑脊液肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)和可溶性B7同源体3(sB7-H3)表达临床研究,旨在为临床治疗提供参考。方法选择医院于2006年1月-2016年12月收治细菌性脑膜炎56例作为研究对象;另选择医院同期收治的病毒性脑膜炎80例作为对照。采集细菌性脑膜炎患者脑脊液标本,进行病原菌分离鉴定且采用纸片扩散法(K-B法)检测耐药性。采用双抗体夹心法酶联免疫吸附法检测TNF-α、MMP-9和可溶性B7-H3水平。结果细菌性脑膜炎56例患者中,共分离培养病原菌78株,以革兰阳性菌为主,其次为革兰阴性菌。鲍氏不动杆菌对头孢哌酮和头孢他啶耐药率较高,分别为93.33%和86.67%。金黄色葡萄球菌对红霉素和青霉素耐药率较高,分别为94.74%和84.21%;肠球菌对红霉素和青霉素耐药率较高,分别为100.00%和93.33%。研究组脑脊液TNF-α、MMP-9和可溶性B7-H3表达水平高于对照组(P<0.05)。结论细菌性脑膜炎病原菌以革兰阳性菌为主,且脑脊液TNF-α、MMP-9和可溶性B7-H3表达明显升高。
OBJECTIVE To explore the etiological characteristics of bacterial meningitis and the expression of cerebrospinal fluid tumor necrosis factor-α(TNF-α),matrix metalloproteinase-9(MMP-9)and soluble B7 homolog 3(sB7-H3)so as to provide guidance for clinical treatment.METHODS A total of 56 patients with bacterial meningitis who were treated in the hospital from Jan 2006 to Dec 2016 were recruited as the study objects,meanwhile,80 patients who had viral meningitis were chosen as the control group.The cerebrospinal fluid specimens were collected from the patients with bacterial meningitis,the pathogens were isolated and identified,the drug resistance was determined by using disk diffusion method(K-B methods),and the levels of TNF-α,MMP-9 and soluble B7-H3 were detected by means of double antibody sandwich enzyme-linked immunosorbent assay.RESULTS Totally 78 strains of pathogens were isolated from 56 patients with bacterial meningitis,gram-positive bacteria were dominant,followed by gram-negative bacteria.The drug resistance rates of Acinetobacter baumannii strains to cefoperazone and ceftazidime were 93.33% and 86.67%,respectively;the drug resistance rates of Staphylococcus aureus strains to erythromycin and penicillin were 94.74%and 84.21%,respectively;the drug resistance rates of Enterococcus strains to erythromycin and penicillin were 100.00% and 93.33%,respectively.The levels of cerebrospinal fluid TNF-α,MMP-9 and soluble B7-H3 of the study group were sighificantly higher than those of the control group(P<0.05).CONCLUSIONThe gram-positive bacteria are dominant among the pathogens isolated from the patients with bacterial meningitis,and the levels of cerebrospinal fluid TNF-α,MMP-9 and soluble B7-H3 are remarkably elevated.
OBJECTIVE To explore the etiological characteristics of bacterial meningitis and the expression of cerebrospinal fluid tumor necrosis factor-α(TNF-α),matrix metalloproteinase-9(MMP-9)and soluble B7 homolog 3(sB7-H3)so as to provide guidance for clinical treatment.METHODS A total of 56 patients with bacterial meningitis who were treated in the hospital from Jan 2006 to Dec 2016 were recruited as the study objects,meanwhile,80 patients who had viral meningitis were chosen as the control group.The cerebrospinal fluid specimens were collected from the patients with bacterial meningitis,the pathogens were isolated and identified,the drug resistance was determined by using disk diffusion method(K-B methods),and the levels of TNF-α,MMP-9 and soluble B7-H3 were detected by means of double antibody sandwich enzyme-linked immunosorbent assay.RESULTS Totally 78 strains of pathogens were isolated from 56 patients with bacterial meningitis,gram-positive bacteria were dominant,followed by gram-negative bacteria.The drug resistance rates of Acinetobacter baumannii strains to cefoperazone and ceftazidime were 93.33% and 86.67%,respectively;the drug resistance rates of Staphylococcus aureus strains to erythromycin and penicillin were 94.74%and 84.21%,respectively;the drug resistance rates of Enterococcus strains to erythromycin and penicillin were 100.00% and 93.33%,respectively.The levels of cerebrospinal fluid TNF-α,MMP-9 and soluble B7-H3 of the study group were sighificantly higher than those of the control group(P<0.05).CONCLUSIONThe gram-positive bacteria are dominant among the pathogens isolated from the patients with bacterial meningitis,and the levels of cerebrospinal fluid TNF-α,MMP-9 and soluble B7-H3 are remarkably elevated.
引文
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[2]Vikse J,Henry BM,Roy J,et al.The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults:a systematic review and meta-analysis[J].Int J Infect Dis,2015,38:68-76.
[3]Sutinen J,Sombrero L,Paladin FJ,et al.Etiology of central nervous system infections in the Philippines and the role of serum C-reactive protein in excluding acute bacterial meningitis[J].Int J Infect Dis,1998-1999,3(2):88-93.
[4]Hu R,Gong Y,Wang Y.Relationship of serum procalcitonin levels to severity and prognosis in pediatric bacterial meningitis[J].Clin Pediatr(Phila),2015,54(12):1141-1144.
[5]任麦青.TNF-α和IL-1β在细菌性脑膜炎患儿血清中的表达及其临床意义[J].中国实用神经疾病杂志,2015,18(14):65-66.
[6]胡亚美,主编.诸福棠实用儿科学[M].第7版.北京:人民卫生出版社,2002:912-926.
[7]叶应妩.全国临床检验操作规程[M].南京:东南大学出版社,1991:1-5.
[8]Inoue S,Takahashi H,Kaneko K.The fluctuations of neuron-specific enolase(NSE)levels of cerebrospinal fluid during bacterial meningitis:the relationship between the fluctuations of NSE levels and neurological complications or outcome[J].Acta Paediatr Jpn,1994,36(5):485-488.
[9]Nhantumbo AA,Gudo ES,Caierao J,et al.Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in children with acute bacterial meningitis in Mozambique:implications for a national immunization strategy[J].BMCMicrobiol,2016,16(1):134.
[10]Bijlsma MW,Brouwer MC,Bossuyt PM,et al.Risk scores for outcome in bacterial meningitis:systematic review and external validation study[J].J Infect,2016,73(5):393-401.
[11]周亚玲.NSE和MMP-9检测在脑膜炎中的诊断价值[J].国际检验医学杂志,2015,36(24):3619-3621.