中枢神经系统感染患儿脑脊液中可溶性细胞间黏附分子-1及白介素-6的变化

目的　探讨中枢神经系统感染患儿脑脊液中可溶性黏附分子 1 (sICAM 1),白介素 6 (IL 6)的变化。方法　2003年 1~12月河北省儿童医院儿科采用酶联免疫吸附法对 65例中枢神经系统感染患儿在不同时期(急性期、恢复期)的脑脊液进行sICAM 1、IL 6水平的测定,并进行对比分析。结果　急性期化脓性脑膜炎组IL 6、sICAM 1质量浓度均明显高于病毒性脑炎组(P<0 05)及对照组(P<0 05),病毒性脑炎组IL 6、sICAM 1亦高于对照组(P<0 05 )。急性期化脓性脑膜炎组WBC与IL 6及sICAM 1呈显著正相关,相关系数分别为0 799、0 728,IL 6与sICAM 1呈显著正相关,相关系数为 0 939。急性期病毒性脑炎组IL 6与sICAM 1呈显著正相关,相关系数为 0 959。结论　sICAM 1及IL 6参与了中枢神经系统感染的病理生理过程,脑脊液中sICAM 1及IL 6质量浓度可以作为监测中枢神经系统感染性疾病发展状态、判断疾病损害程度的可靠指标。可为化脓性脑膜炎、病毒性脑炎的鉴别诊断提供实验室根据。     

柯萨奇B3病毒VP1序列变异与小儿中枢神经系统损害关系的探讨

目的 探讨柯萨奇B3(CoxB3)脑炎和脑膜炎患儿脑脊液中病毒VP1段基因和氨基酸序列变异与中枢神经系统损害的关系.方法 肠道病毒通用引物扩增阳性的脑脊液标本再用VPl分型引物进行扩增、克隆、测序,VP1基因序列(450 bp)结果通过NCBI网站上的BLAST程序进行翻译及比对.结果肠道病毒通用引物扩增阳性的73例患儿中,分型引物检测21例为CoxB3中枢神经系统感染.4例引起重型脑炎的CoxB3 VP1段第856氨基酸位点上由谷氨酰胺变异为组氨酸;而引起轻型脑炎的其他3例CoxB3和引起脑膜炎的14例CoxB3的VP1基因序列均未发现规律性的氨基酸变异.4例重症脑炎患儿改良的Glasgow昏迷评分均小于7分,3例意识障碍时间均小于3 d,1 例脑萎缩明显的患儿,Glasgow昏迷评分4分,昏迷13.5 d,留有严重的癫(癎)发作.结论本地区2005年夏、秋存在着CoxB3中枢神经系统感染的局部小流行,肠道病毒VP1氨基酸序列的变异可能是导致病毒的毒力增加及对中枢神经系统损害加重的主要原因.     

中枢神经系统感染患儿脑脊液和血清胰岛素样生长因子Ⅱ水平的变化及意义

目的　探讨中枢神经系统 (CNS)感染患儿脑脊液 (CSF)中胰岛素样生长因子 Ⅱ (IGF Ⅱ )水平的变化及其与CSF中葡萄糖浓度、蛋白质浓度和白细胞计数的关系。方法　 45例CNS感染患儿分为 2组 ,其中细菌性脑膜炎 (BM) 2 4例、病毒性脑炎 (VE) 2 1例 ,取 15例无神经系统疾病患儿的CSF作为对照组。用免疫放射分析法 (IRMA)测定CSF中IGF Ⅱ的浓度。结果　 1.BM组CSF中IGF Ⅱ浓度 64 .5 6± 49.61ng/ml显著高于VE组 3 1.41± 7.16ng/ml(P <0 .0 1)和对照组 2 7.19± 6.85ng/ml(P <0 .0 1) ;2 .CSF中IGF Ⅱ浓度与CSF中葡萄糖浓度呈负相关 (r =- 0 .5 61　P <0 .0 1) ,与CSF中蛋白浓度呈正相关 (r =0 .83 9　P <0 .0 0 1)。结论　1.IGF Ⅱ参与CNS感染的病理生理过程 ;2 .IGF Ⅱ可能参与CNS感染时CSF中葡萄糖和蛋白浓度变化的调节 ;3 .测定CSF中IGF Ⅱ浓度可对BM和VE的鉴别诊断提供帮助。     

Elevation of cerebrospinal fluid sialic acid concentration in children with central nervous system leukemia

We studied sialic acid in the cerebrospinal fluid (CSF) of 52 children with leukemia and 51 children with non-leukemic diseases. The CSF sialic acid concentration in the children with central nervous system (CNS) leukemia was significantly higher than that in the children with acute lymphoblastic leukemia without CNS involvement, acute non-lymphocytic leukemia without CNS involvement, non-hemopoietic diseases, non-suppurative meningitis, epilepsy, and other neurologic diseases. Serial determinations revealed a rapid decline in the CSF sialic acid concentrations in the patients with CNS leukemia who responded well to the therapy and who were free from relapse of CNS leukemia. The simultaneously determined CSF beta 2 microglobulin concentration did not show any significant changes. These results suggest that the CSF sialic acid may be a good indicator of CNS leukemia.     

Immunoglobulins in cerebrospinal fluid in central nervous system disorders

Immunoglobulins were estimated in the cerebrospinal fluid from 70 cases of nervous system diseases. Thirty childern with evidence of C.N.S. irritation without infection served as controls. The immunoglobulins were higher in cases with C.N. S infections. Within this group meningeal involvement (tubercular and pyogenic) resulted in a significant rise in IgG compared to viral encephalitis. The proportion of immunoglobulin in the CSF protein can be helpful in distinguishing TBM from PM.     

Immunoglobulins in cerebrospinal fluid in central nervous system disorders

Immunoglobulins were estimated in the cerebrospinal fluid from 70 cases of nervous system diseases. Thirty childern with evidence of C.N.S. irritation without infection served as controls. The immunoglobulins were higher in cases with C.N. S infections. Within this group meningeal involvement (tubercular and pyogenic) resulted in a significant rise in IgG compared to viral encephalitis. The proportion of immunoglobulin in the CSF protein can be helpful in distinguishing TBM from PM.     

脑脊液细胞因子检测在小儿中枢神经系统感染鉴别诊断中的意义

目的　探讨脑脊液 (CSF)γ 干扰素 (IFN γ)、粒细胞集落刺激因子 (G CSF)、α肿瘤坏死因子 (TNF α)、白细胞介素 6 (IL 6 )及白细胞介素 8(IL 8)的变化在小儿中枢神经系统感染 (CNSI)中的诊断价值。方法　采用双抗体夹心ELISA法检测 14例化脓性脑膜炎 (PM)、30例病毒性脑膜炎 (VM)及2 2例非中枢神经系统感染患儿CSF中IFN γ、G CSF、TNF α、IL 6及IL 8水平。结果　PM组G CSF及IL 8[(132± 4 1)、(2 5 3± 0 5 6 ) μg/L]水平明显高于VM组 [(5 3± 2 2 )、(0 5 3± 0 4 6 ) μg/L](P <0 0 0 1) ;IFN γ在VM组 [(2 0± 0 4 ) μg/L]水平明显高于PM组 [(0 8± 0 5 ) μg/L](P <0 0 1) ;各脑膜炎组中TNF α及IL 6水平均高于对照组 (P <0 0 0 1) ,但各组间比较差异无显著性。G CSF及IL 8水平增高程度与CSF中性粒细胞计数呈正相关 ;IFN γ增高程度与CSF白细胞数及葡萄糖定量间无相关性。结论G CSF、INF γ及IL 8在CSF中显著增高有助于PM与非PM的鉴别诊断 ;TNF α、IL 6在感染性脑膜炎发病过程中的作用是非特异性的 ,其在CSF中的变化对感染性脑膜炎患儿鉴别诊断无临床意义     

Interleukin-6 in cerebrospinal fluid of patients with central nervous system infections

Interleukin(IL)-6 levels were measured in cerebrospinal fluid (CSF) and serum samples from pediatric patients with central nervous system (CNS) infections by means of an enzyme-linked immunosorbent assay. Mean IL-6 concentrations in CSF samples from patients with bacterial meningitis (49017 44 730 pg/ml) were significantly higher than those in patients with aseptic meningitis (10761572 pg/ml) or encephalitis (409835 pg/ml). In aseptic meningitis and encephalitis, IL-6 levels in serum were within the lower ranges (< 100 pg/ml), in contrast with the highly elevated levels found in bacterial meningitis (14 33218 385 pg/ml). In 5 of the 15 patients with encephalitis, elevated levels of IL-6 were observed in the initial CSF samples despite normal findings of routine CSF examinations. Also, sequential CSF samples revealed that there was an increase in the CSF cell count in two of the five patients. These results validated the potential of measuring IL-6 in CSF samples for the purpose of providing additional information on routine laboratory test results. D Central nervous system infection, cerebrospinal fluid, children, enzyme-linked immunosorbent assay, interleukin-6.
M Narita, Department of Pediatrics, Hokkaido University School of Medicine, N 15 W 7, Kita-ku, Sapporo 060, Japan     

脑脊液游离轻链检测在儿童中枢神经系统感染中的应用

目的探讨脑脊液(CSF)游离轻链检测在儿童中枢神经系统感染中的应用价值。方法用BN-Ⅱ特定蛋白分析仪检测24例病毒性脑炎患儿、7例化脓性脑膜炎患儿及12例CSF正常患儿的血清及CSF中白蛋白(ALB)、免疫球蛋白G(IgG)、游离轻链;用免疫固定电泳检测IgG寡克隆区带;计算白蛋白商值(QALB)、IgG商值(QIgG)、Kappa商值(Qκ)、Lamda商值(Qλ),并进行对比分析。结果所有患儿CSF寡克隆区带均为阴性;病毒性脑炎组和化脓性脑膜炎组患儿的QALB、QIgG、Qκ、Qλ显著高于CSF正常对照组(P均<0.05),化脓性脑膜炎组QALB、QIgG显著高于病毒性脑炎组(P均<0.01),病毒性脑炎组Qκ、Qλ与化脓性脑炎组比较,差异均无统计学意义(P>0.05);QIgG、Qλ随血脑屏障损害程度的加深呈递增趋势(P均<0.05);所有研究对象的QALB与QIgG、QALB与Qκ、QALB与Qλ、QIgG与Qκ、QIgG与Qλ、Qκ与Qλ均有相关性(r=0.320～0.814,P均<0.05)。结论游离轻链检测对儿童化脓性脑膜炎和病毒性脑炎的诊断有较大帮助,且Qλ能较好的反映患儿血脑屏障的损伤程度。