促炎因子在低龄化脓性脑膜炎患儿病情严重程度及预后中的应用价值

目的探讨4种促炎因子在低龄化脓性脑膜炎（purulent meningitis,PM）患儿早期诊断、病情评估和预后中的价值。 方法选取2岁以下的PM患儿25例，其中普通PM组17例，重症PM组8例，同时选取对照组18例，入院后12 h内采集脑脊液（cerebrospinal fluid，CSF）和血液。应用酶联免疫吸附剂测定法测定CSF和血清中肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素（interleukin,IL）1β、IL-6和IL-8的浓度。随访6个月，评估患儿的预后情况。 结果CSF IL-6和CSF IL-8诊断小儿PM的受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积（area under curve，AUC）分别为0.932和0.916，其诊断效能高于其他指标。重症PM组CSF中TNF-α、IL-1β、IL-6和IL-8水平均高于普通PM组的水平（P＜0.05），普通PM组CSF促炎因子水平高于对照组（P＜0.05）。在区分普通PM和重症PM的ROC曲线中，CSF TNF-α的AUC最大，当CSF TNF-α取截断值为70.4 ng/L时，其区分重症PM的敏感度为100%、特异度为94.1%。预后不良组CSF IL-6水平显著高于预后轻度不良组，预后轻度不良组CSF IL-6水平明显高于预后良好组（P＜0.05）。 结论CSF中的IL-6和IL-8可作为低龄儿童PM的早期辅助诊断指标。CSF中TNF-α水平有助于反映低龄儿童PM病情的严重程度。CSF中IL-6水平可能对PM患儿的远期预后有一定的预测作用。

Clinical value of pro-inflammatory cytokines in assessing disease severity and prognosis of early childhood purulent meningitis

ObjectiveTo evaluate the clinical value of pro-inflammatory cytokines in early diagnosis, evaluation of disease severity and prognosis of early childhood purulent meningitis(PM).MethodsA total of 25 children aged 2 years or younger with PM were enrolled and divided into two groups based on the pathogenetic severity, namely general PM group(n=17), and severe PM group(n=8). 18 non-CNS infection children were chosen as the control group. Blood and CSF were collected within the first 12 hours after hospitalization. The level of tumor necrosis factor-α（TNF-α）, interleukin（IL）-1β, IL-6 and IL-8 was measured by enzyme linked immunosorbent assay(ELISA). Long-term prognosis was evaluated at 6 months of follow-up.ResultsThe AUC of ROC curve was 0.932 for CSF IL-6, 0.916 for CSF IL-8, which suggested that the diagnostic efficiency of CSF IL-6 and CSF IL-8 were higher than that of other parameters. All four cytokines were higher in CSF than in serum（P＜0.05）, and the CSF levels of TNF-α, IL-1β, IL-6 and IL-8 were significantly higher in severe PM group than with general PM group. According to the ROC curve in distinguishing the severity of PM, the AUC of CSF TNF-α was largest. When the level of CSF-TNF-α was 70.4 ng/L, the Youden Index was the biggest, and the sensitivity and specificity were 100% and 94.1%, respectively. Levels of CSF IL-6 in poor prognosis group were obviously increased in comparison with that of mild poor prognosis group with a statistical difference(P＜0.05), and levels of CSF IL-6 in mild poor prognosis group was significantly higher than that in good prognosis group(P＜0.05).ConclusionCSF IL-6 and IL-8 can be used as auxiliary indicators in early diagnosis of early childhood PM. CSF TNF-α may be helpful to evaluate the severity of early childhood PM. CSF IL-6 is expected to have value for the evaluation of the long-term prognosis of early childhood PM.