CNSI患者血浆中uPA及其受体（uPAR）的变化和临床意义

目的：研究中枢神经系统感染（CNSI）患者血浆中尿激酶型纤溶酶原激活物（uPA）及其受体（uPAR）的变化及意义。方法：收集我院2006年10月～2008年7月CNSI住院患者69例,将CNSI病例分为病毒性脑炎组、结核性脑膜炎组、化脓性脑膜炎组,并设立对照组。用双抗体夹心酶联免疫法检测所有CNSI病例血浆中uPA及其受体（uPAR）水平。结果：化脓性脑膜炎组、结核性脑膜炎组uPA及其受体（uPAR）水平明显高于病毒组及对照组（P〈0.01）,血浆uPAR浓度改变与uPA同步,但uPAR升高水平高于uPA。结论：血浆中uPA及其受体（uPAR）水平在化脓性脑膜炎、结核性脑膜炎中升高,可为化脓性脑膜炎、结核性脑膜炎、病毒性脑炎的鉴别诊断提供更多的实验室依据。     

毛细支气管炎患儿血浆CGRP、VIP RIA的意义

目的：通过愉洲毛细支气管炎患儿急性期和恢复期血浆中降钙素基因相关肽（CCRP）、血管活性肠肽（VIP）的含量,探讨毛细支气管炎患儿血浆CGRP、VIP放射免疫分析（RIA）的意义。方法：本文采用放射免疫分析测定了31例毛细支气管炎患儿急性期和恢复期血浆CGRP、VIP的浓度,以35例正常婴幼儿血浆CGRP、VIP的浓度为对照。结果：毛细支气管炎患儿急性期血浆CGRP浓度明显高于恢复期及正常对照组婴幼儿（P〈0．05）;恢复期CGRP浓度有所下降,但仍高于正常对照组（P〈0．05）,三组间有显著差异（F=82．50,P〈0．01）;毛细支气管炎患儿急性期血浆VIP浓度明显低于恢复期及正常对照组婴幼儿（P〈0．05）;恢复期V1P浓度有所升高,但仍低于正常对照组（P〈0．05）;三组之间有显著性差异（F=300．20,P〈0．01）。结论：CGRP、VIP定量分析结果表明毛细支气管炎患儿血浆CGRP、VIP含量与病程紧密相关。CGRP、VIPRIA对于小儿毛细支气管炎发病机制的研究以及了解其发病病程和指导治疗有着重要的意义。     

磁共振3D-ASL定量评估儿童病毒性脑炎脑灌注特征

目的:探讨儿童病毒性脑炎的磁共振三维动脉自旋标记（3D-ASL）成像的灌注特征。方法:回顾性收集25例急性病毒性脑炎患儿和25名年龄相仿的健康对照组。在脑血流量（CBF）伪彩图上对每个患者进行视觉评估，定量分析病变区与对照组CBF值差异，确定儿童病毒性脑炎的脑灌注特征。结果:25例病毒性脑炎患儿在急性期灌注显著增高，急性病变的CBF值、标准化CBF值显著高于对照组，其ROC-AUC值分别为0.971和0.992。9例患儿在治疗好转后进行复查，病变区血流灌注随病情好转而减低。结论:儿童病毒性脑炎的3D-ASL成像表现有一定特征，病灶在急性期灌注显著增高，病情好转后减低。3D-ASL可以为儿童病毒性脑炎诊断和随访提供一种新的影像学参考。     

病毒性脑炎患儿脑脊液NO含量与临床意义

目的探讨病毒性脑炎患儿脑脊液一氧化氮含量(NO)变化与脑损伤程度的相关性.方法用比色法检测37例病毒脑及20例正常对照儿脑脊液NO含量.结果病毒脑患儿脑脊液NO含量明显高于对照组 ,脑损伤重者NO含量更高,急性期的脑脊液NO含量明显高于恢复期.结论病毒脑患儿脑脊液NO含量升高,增高幅度与脑损伤程度有关,NO含量测定有助于脑脊液常规及生化正常的病毒脑的诊断.     

病毒性脑炎患儿脑脊液NO含量与临床意义

目的：探讨病毒性脑炎患儿脑脊液一氧化氮含量(NO)变化与脑损伤程度的相关性．方法：用比色法检测37例病毒脑及20例正常对照儿脑脊液NO含量．结果：病毒脑患儿脑脊液NO含量明显高于对照组，脑损伤重者NO含量更高，急性期的脑脊液NO含量明显高于恢复期．结论：病毒脑患儿脑脊液NO含量升高，增高幅度与脑损伤程度有关，NO含量测定有助于脑脊液常规及生化正常的病毒脑的诊断．     

病毒性脑炎患者S-100b蛋白浓度与临床的相关性

目的 观察病毒性脑炎急性和恢复期患者血液和脑脊液的S-100b蛋白浓度变化，探讨其与异常脑电图和影像学低密度灶体积等方面的相关性。方法 42例病毒性脑炎住院患者为观察组，25例与观察组相匹配的阑尾或胆囊摘除手术病人以及健康体检者为对照组，采用双抗体夹心ELISA法，检测其血液及脑脊液100b蛋白浓度；并应用SPSS10．0统计软件包进行统计学分析。结果病毒性脑炎急性期患者血液和脑脊液S-100b蛋白显著高于恢复期患者和对照组（P〈0．01）；血液和脑脊液S-100b蛋白浓度与低密度灶体积均呈显著正相关（rCSF=0．756，P〈0．01；r血液=0．685，P〈0．01）；轻度、中度及重度异常脑电图患者脑脊液S-100b蛋白浓度均高于血液（P〈0．01）；重度、中度异常脑电图患者血液及脑脊液S-100b蛋白浓度均高于轻度（P〈0．01）。结论脑脊液或血液中的S-100b蛋白浓度反映了神经胶质细胞的损害程度，也是脑组织破坏后较合适的生化标记物，对监测病毒性脑炎患者的病情变化和疗效观察具有重要价值。     

急性呼吸道腺病毒感染患儿血清细胞因子的动态变化

目的探讨急性呼吸道腺病毒（AdV）感染患儿的细胞因子水平,及其在腺病毒感染发病与发展中的致病作用及意义。方法采集临床住院患儿血清和咽拭子,分别用酶联免疫法（ELISA）及实时荧光定量PCR法检测AdV-IgM及AdV核酸,两者结果均为阳性者入选AdV感染组。采用流式细胞蛋白分析技术（CBA）检测20例AdV感染者急性期、恢复期和20例正常对照儿童血清IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ及IL-17A。结果 AdV感染患儿急性期血清中的IL-2、IL-4、IL-6、TNF、IL-17A水平显著高于恢复期和正常对照组（P〈0.01）;而血清中的IL-10、IFN-γ水平急性期显著低于恢复期和正常对照组（P〈0.05）;恢复期和正常对照组相比差异无统计学意义（P〉0.05）。结论儿童急性呼吸道腺病毒感染会引起细胞因子水平的改变,它们在血清中水平失衡,对发病及病情的发展有一定影响。     

脑脊液β2-m、SF、LDH及CK检测对小儿化脓性脑膜炎与病毒性脑炎的鉴别诊断价值

目的:通过对脑脊液β2-微球蛋白(β2-m)、铁蛋白(SF)含量及乳酸脱氢酶(LDH)、肌酸激酶(CK)活性的检测,快速鉴别诊断小儿化脓性脑膜炎(化脓脑)与病毒性脑炎(病毒脑).方法:选择用药前50例化脓脑患儿(化脓脑组),58例病毒脑患儿(病毒脑组),30例对照组小儿脑脊液,用放射免疫分析(RIA)测其β2-m,化学发光法(CLIA)测其SF含量,速率法测其LDH、CK活性.结果:脑脊液β2-m、SF含量,化脓脑组、病毒脑组均显著高于对照组(P＜0.01),化脓脑组均显著高于病毒脑组(P＜0.01);LDH、CK活性化脓脑组均显著高于病毒脑组(P＜0.01).结论:脑脊液β2-m、SF、LDH、CK检测,对小儿化脓脑与病毒脑具有一定的辅助鉴别诊断价值.     

传染性单核细胞增多症患儿细胞因子与T细胞亚群动态变化及临床意义

目的研究传染性单核细胞增多症（IM）患儿细胞免疫功能动态变化及其临床意义。方法采用ELISA法和流式细胞仪分别检测了38例生长发育正常的IM患儿急性期和恢复期血清IL-6、IL-8和外周血T淋巴细胞亚群,并与36例同龄健康儿童组比较。结果急性期IM患儿血清IL-6、IL-8、CD3、CD8明显高于对照组及恢复期（P〈0.01）,CD4、CD4/CD8比值明显低于对照组及恢复期（P〈0.01）,恢复期患儿血清CD4升高,IL-6、IL-8、CD3、CD8降低,与对照组比较无显著性差异（P〉0.05）,CD4/CD8比值仍低于对照组（P〈0.05）,但高于急性期（P〈0.01）。结论 EB病毒感染后机体细胞免疫功能异常是IM发病的关键,为IM患儿的免疫治疗提供了理论依据。     

闽东地区小儿颅内感染52例临床分析

目的 探讨小儿各型颅内感染的临床表现、脑脊液及CT影像学检查在鉴别诊断中的价值。方法 本文回顾性分析了52例1996年3月-2003年5月闵东医院住院的颅内感染患儿的临床表现、脑脊液常规检查及CT影像学表现。结果 脑脊液白细胞数在各型颅内感染中无显著性差异,各组间P>0.05;蛋白含量细菌性感染组(包括化脓性脑膜炎及结核性脑膜炎)显著高于无菌性感染组(包括病毒性脑炎及流行性乙型脑炎),P<0.001;糖含量则前组显著低于后组,P<0.01;组内无显著性差异,P>0.05。氯化物含量结脑显著低于其余各组,P<0.01。结论 脑脊液生化常规对各型颅内感染具有鉴别诊断意义。白细胞计数不能作为鉴别的金标准。CT检查对结脑患儿诊断意义较大。     

Diagnostic value of heparin-binding protein in the cerebrospinal fluid for purulent meningitis in children

This study aimed to investigate the diagnostic value of heparin-binding protein (HBP) in the cerebrospinal fluid of children with purulent meningitis (PM). This study included 118 children with PM diagnosed at our hospital from January 2018 to January 2020, 110 children with viral meningitis (VM) and 80 children with suspected meningitis who were ruled out by cerebrospinal fluid (CSF) analysis during the same period. HBP and white blood cell (WBC) count in the CSF, and inflammatory factors, including C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and procalcitonin (PCT), were measured. Receiver-operator characteristic curves were used to analyze the predictive value of HBP, CRP, PCT, and TNF-α levels in the diagnosis of PM by CSF analysis. HBP levels in the CSF of children with PM were higher, while the CRP and serum PCT and TNF-α levels were elevated in all groups (P<0.05). In addition, HBP levels in the CSF were more accurate for the diagnosis of PM than traditional diagnostic indexes. HBP levels in the CSF can be used as an important reference for early diagnosis of PM.     

过敏性紫癜患儿Th17、Treg 细胞及IL-17、IL-23 水平的测定

目的:观察过敏性紫癜(Henoch-Schonlein purpura,HSP)患儿急性期及恢复期Th17、Treg 细胞及IL-17、IL-23水平变化,以便更好地认识HSP 的免疫学发病机制,为HSP 的治疗提供帮助。方法:采用流式细胞术(Flow cytometry,FCM)检测HSP 患儿65 例和健康对照组儿童30 例外周血中Th17 细胞和Treg 细胞比例;采用双抗体夹心酶联免疫吸附(ELISA)法测定其血浆中IL-17、IL-23 水平。结果:HSP 急性期组Th17、Th17/ Treg 细胞及IL-17、IL-23 水平高于正常对照组(P<0.05),恢复期组较急性期组降低(P<0.05),但仍高于正常对照组(P<0.05)。HSP 急性期组Treg 水平低于正常对照组(P<0.01),恢复期组较急性期组升高(P<0.01),但是仍低于正常对照组(P<0.01)。单纯型、腹型和其他类型HSP 患儿Th17、Treg、Th17/ Treg 及IL-17、IL-23 水平相同(P>0.05)。HSP 急性期患儿Th17 细胞比例与IL-17 水平呈正相关(r =0.880,P<0.01);HSP 急性期患儿IL-23 水平与Th17 细胞比例、IL-17 水平呈正相关(r =0.838 或r =0.877,P<0.01)。结论:Th17、Treg、Th17/ Treg、IL-17 和IL-23 共同参与HSP 的发病,但在单纯型、腹型和其他类型中的水平无明显差异,值得深入研究。     

Comparative values of CSF-LDH isoenzymes in neurological disorders

The present study was carried out to evaluate the usefulness of Cerebrospinal fluid (CSF) Lactate dehydrogenase (LDH) isoenzymes in the diagnosis in tuberculous meningitis (TBM), pyogenic meningitis (PM), viral encephalitis (VE) and hydrocephalus (HC). A characteristic dominance of isoenzymes in cerebrospinal fluid was observed: LDH4 in TBM while LDH3 in PM. However, in VE and HC, LDH2 and LDH1 were dominant respectively. The control subjects revealed the presence of isoenzymes LDH1 and LDH2 in very low concentrations. Pattern of LDH isoenzymes in CSF may serve as a diagnostic tool to differentiate these neurological disorders.     

Combination ELISAs for antiviral antibodies in CSF and serum in patients with neurological symptoms and in healthy controls

A combination enzyme-linked immunosorbent assay (ELISA) was designed to improve the estimation of serum: cerebrospinal fluid (CSF) antiviral IgG ratios. Microplate wells were coated with five different virus antigens. Serum and CSF from 66 patients referred for CSF serology and from 21 healthy controls were studied. In a comparison with serum: CSF IgG titre ratios, absorbance ratios were found to be suitable for the evaluation of intrathecal antiviral IgG synthesis. A slight blood-brain barrier (BBB) disturbance affected only the passage of albumin over the BBB, whereas a more pronounced BBB defect resulted in increased IgG levels in the CSF. Intrathecal antiviral IgG synthesis was demonstrated in 15 patients with viral CNS infections or inflammatory diseases. Very high serum: CSF antiviral IgG titre ratios and absorbance ratios, found in six patients, were interpreted as signs of diminished IgG passage over the BBB due to impaired CSF circulation.     

Soluble interleukin-6 receptor (sIL-6R) in cerebrospinal fluid of patients with inflammatory and non inflammatory neurological diseases

IL-6 acts on target cells via the ligand-binding protein interleukin-6 receptor (IL-6R) and the affinity-converting and signal-transducing glycoprotein 130 (gp130). Soluble interleukin-6 receptor (sIL-6R) has an agonistic role because the soluble complex (IL-6/sIL-6R) can activate cells that do not express IL-6R and an antagonistic role as it enhances the inhibitory activity of sgp130. Soluble forms of both receptors, sIL-6R and sgp130, regulate the action of IL-6. sIL-6R was measured by a sensitive enzyme-linked immunosorbent assay in paired sera and cerebrospinal fluid (CSF) from 46 patients with inflammatory neurological diseases (IND), 45 patients with relapsing-remitting multiple sclerosis (RR-MS), 13 patients with primary progressive multiple sclerosis (PP-MS), 17 patients with other non inflammatory neurological diseases (NIND) and 13 mentally healthy individuals--healthy controls (HC). Patients with RR-MS had CSF sIL-6R levels comparable to those from patients with IND, but higher than patients with NIND and HC. A positive correlation between the CSF/serum albumin (QAlb) and CSF sIL-6R levels was observed in IND but not in RR-MS patients indicating that CSF sIL-6R levels in IND patients could be influenced by serum sIL-6R and blood brain barrier (BBB) permeability properties. RR-MS patients had higher values of [CSF/serum sIL-6R:CSF/serum albumin] (sIL-6R index) than IND patients suggesting that in multiple sclerosis (MS), the increase in CSF sIL-6R could be due to intrathecal synthesis of sIL-6R. The finding of increased CSF sIL-6R concentrations (>979 pg/ml) with sIL-6R index (>4.66), in correlation with positive oligoclonal bands in RR-MS patients, suggests that values of sIL-6R index > 4.66 indicate intrathecal increase of sIL-6R and might be used as an indicator of neuroimmunoregulatory and inflammatory processes in the central nervous system (CNS).     

出血性脑损伤患者脑脊液和血清中S100β蛋白的意义

目的:观察脑出血患者CSF和血清中S100β蛋白含量的变化及其临床意义。方法:以25例腹股沟疝和大隐静脉曲张患者作为25例脑出血患者对照组,取CSF和血清;将24只家兔随机分为两组(每组12只),一组实验组,另一组为假手术组。分别于实验性脑出血后6 h、12 h、24 h、48 h、72 h、96 h等各时间点取各组CSF和血清,采用ELISA法测定S100β蛋白的含量。结果:脑出血患者急性期与恢复期脑脊液中S100β蛋白的水平明显高于对照组(P<0.01);也明显高于血清S100β蛋白的水平(P<0.01);不同时间点兔脑出血模型实验组脑脊液中S100β蛋白的水平明显高于假手术组(P<0.01)。结论:脑出血后S100β蛋白在脑脊液中持续时间较长,且含量显著增高,可作为出血性脑损伤的早期诊断、指导治疗、判断预后的检测指标。     

Levels of serum immunoglobulin G, CSF IgG and IgG index in acute bacterial meningitis.

This study characterised the levels of serum immunoglobulin G (IgG), cerebrospinal fluid IgG (CSF IgG) and IgG index as an aid to the diagnosis and prognosis of acute bacterial meningitis (ABM). A total of 28 patients with proven ABM at admission (age range: one month to 10 years; 17 males, 11 females) (group A) and 17 age- and sex-matched control children (group B) were studied. Levels were also compared between patients with neurological morbidity (n = 4; group C) and without neurological morbidity (n = 24; group D) who were subsets of group A. In addition, patients were divided randomly into two groups based on the treatment received (i.e. ceftriaxone together with dexamethasone [n = 11; group A1] and ceftriaxone only [n = 9; group A2] to assess the effect of dexamethasone. The results (mean +/- SEM) demonstrated intrathecal synthesis of IgG in ABM (group A vs group B: CSF IgG (mg/L): 92.64 +/- 23.54 vs 2.12 +/- 1.08, P < 0.002; IgG index: 0.959 +/- 0.481 vs 0.029 +/- 0.006, P < 0.001) which showed good diagnostic significance. In the patients with permanent neurological morbidity (group C) vs healthy survivors (group D), the CSF IgG and IgG index showed good prognostic significance (group C vs group D: CSF IgG (mg/L): 10.75 +/- 9.75 vs 106.24 +/- 29.37, P < 0.01; IgG index: 0.046 +/- 0.039 vs 1.132 +/- 0.568, P < 0.05). Dexamethasone lowered CSF-IgG and IgG-index levels, but the effect was not statistically significant (group A1 vs group A2: P > 0.1).     

Comparison of the levels of human herpesvirus 6 (HHV‐6) DNA and cytokines in the cerebrospinal fluid and serum of children with HHV‐6 encephalopathy

Primary human herpesvirus‐6 (HHV‐6) infection is a common cause of acute sporadic encephalopathy in Japanese children. Occasionally, HHV‐6 is not detected in the cerebrospinal fluid (CSF) of patients with encephalopathy, for example, in those with focal viral encephalitis, such as herpes simplex viral encephalitis. This indicates that HHV‐6 encephalopathy is caused by an indirect mechanism, although this is not fully understood. HHV‐6 DNA, cytokines (interleukin (IL)‐1β, IL‐6, IL‐8, IL‐10, IL‐12 p70, tumor necrosis factor‐α, interferon‐γ), and matrix metalloproteinase‐9 were quantitated in both the CSF and serum of 13 patients with HHV‐6 encephalopathy during the acute phase of the disease. HHV‐6 DNA was detected in the CSF of seven patients with HHV‐6 encephalopathy. The viral DNA concentration was significantly higher in serum than in CSF (mean 1.64 × 10⁴ vs. 5.70 × 10¹ copies/ml; P = 0.003). The lack or low level of viral DNA in the CSF samples suggests that direct invasion of the central nervous system by HHV‐6 is not the main cause of encephalopathy. Additionally, the IL‐10 concentration was significantly higher in serum than in CSF (P < 0.001), whereas there was no significant difference in IL‐6 levels between the CSF and serum samples. Interestingly, the IL‐8 concentration was significantly higher in CSF than in serum (P = 0.038). The distribution of these cytokines differed between CSF and serum. The high CSF concentration of IL‐8 could play an important role in the pathogenesis of encephalopathy. J. Med. Virol. 82:1410–1415, 2010. © 2010 Wiley‐Liss, Inc.     

血清降钙素原水平分级在慢性阻塞性肺疾病急性加重期的临床价值探讨

目的:探讨血清降钙素原(Procalcitonin,PCT)水平分级在慢性阻塞性肺疾病急性加重期(Acute exacerbation ofchronic obstructive pulmonary disease,AECOPD)的临床价值。方法:以48例进入本研究的慢性阻塞性肺疾病急性加重期患者作为病例组,另随机抽取同期住院的45例普通肺炎患者作为对照组。两组均于24h内测定血清PCT、血常规、C反应蛋白(C-reactiveprotein,CRP)及进行痰培养,同时将病例组按PCT水平分为<0.05、0.05～1.0、1.0～10、10～20、≥20ng.ml-1五个等级,并分析各组的抗生素使用时间、住院时间、痰培养阳性、好转及死亡。结果:病例组血清PCT明显高于对照组,且有统计学意义(P<0.05),而两组WBC计数、CRP均无统计学意义(P>0.05)。随着血清PCT水平的逐渐升高,病例组好转率逐渐下降,抗生素使用时间与需住院时间也延长,痰培养阳性、病死率均呈逐渐上升的趋势(P<0.05)。结论:血清PCT水平分级对慢性阻塞性肺疾病急性加重期的病情诊断、评估预后有指导意义。     

Diagnosis of leukemia or lymphoma in the central nervous system by beta 2-microglobulin determination

To detect early relapse in the central nervous systems (CNS) of patients with acute leukemia or lymphoma, we measured levels of beta 2-microglobulin (beta 2 m) in serum and cerebrospinal fluid (CSF). CSF levels were significantly higher in patients with leukemia (P < 0.001) or lymphoma (P < 0.02) with clinical evidence of CNS involvement than in those without this complication. When serum and CSF levels were measured simultaneously, the CSF level of beta 2 m was significantly higher than the serum level in patients with acute leukemia and lymphoma with CNS involvement (P = 0.05), but not in patients without CNS involvement. Serial determination of CSF beta 2 m correlated well with the clinical appearance and disappearance of CNS involvement. These data suggest that serial and simultaneous determination of beta 2 m in serum and CSF may be useful in early diagnosis of CNS involvement and in monitoring intrathecal therapy in patients with acute leukemia or lymphoma.