脑脊液和血降钙素原联合检测在颅内感染患者中的临床价值

目的观察脑脊液降钙素原(PCT)和血降钙素原在不同颅内感染患者中的表达。方法收集郑州大学第一附属医院神经内科2016-09—2017-09收治的59例急性颅内感染患者的临床资料,化脓性脑膜炎29例,病毒性脑膜炎30例,收集脑脊液和血液样本,检测脑脊液降钙素原和血降钙素原进行统计分析。结果化脓性脑膜炎组脑脊液PCT(1.10±1.36)ng/mL,血PCT(1.34±2.67)ng/mL;病毒性脑膜炎组脑脊液PCT(0.23±0.44)ng/mL,血PCT(0.43±1.32)ng/mL,差异有统计学意义(P0.05)。依据ROC曲线,以脑脊液PCT浓度≥0.24 ng/mL、血PCT浓度≥0.17 ng/mL为阳性阈值,脑脊液PCT、血清PCT对颅内感染诊断的敏感度分别为76%、79%,特异性分别为83%、80%。并联试验显示脑脊液和血清PCT联合检测诊断颅内感染的灵敏度89%、特异度70%。结论脑脊液和血PCT在颅内感染的诊断中均有意义,临床价值更大。     

血清降钙素原在鉴别小儿不典型化脓性脑膜炎和病毒性脑炎的作用

目的 对比血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞数(WBC)在鉴别不典型化脓性脑膜炎和病毒性脑炎中的价值.方法 把研究对象分为3组,分别为病毒性脑炎组(viral encephalitis)、不典型化脓性脑膜炎组(atypical bacterial meningitis)和典型化脓性脑膜炎组(typical bacterial meningitis),另选20名性别年龄匹配的正常儿童作为正常对照组(normal control group),分别测PCT值、CRP值和WBC值,各组指标比较应用独立样本t检验及卡方检验,并应用ROC曲线比较三者在鉴别病毒性脑炎和不典型化脓性脑膜炎的敏感性和特异性.结果 血清PCT在不典型化脓性脑膜炎、化脓性脑膜炎组与病毒性脑膜炎组、正常对照组之间差异有统计学意义;血清CRP在病毒性脑炎与化脓性脑膜炎之间差异有统计学意义,但在不典型化脓性脑膜炎与病毒性脑膜炎组之间差异无统计学意义;血清WBC在病毒性脑炎组和不典型化脓性脑膜炎组之间差异无统计学意义,但在典型化脓性脑膜炎组与病毒性脑膜炎组差异有统计学意义.不典型化脓性脑膜炎组与病毒性脑炎组中,PCT对不典型化脓性脑膜炎诊断的ROC曲线下面积93.9%,大于WBC和CRP.结论 不典型化脓性脑膜炎时,PCT升高,病毒性脑炎时PCT升高不明显.PCT在鉴别不典型化脓性脑膜炎和病毒性脑炎时有一定临床应用价值.     

小儿化脓性脑膜炎脑脊液中HBP和VE-cadherin的水平变化及其对预后的预测价值

目的 探讨小儿化脓性脑膜炎脑脊液肝素结合蛋白(Heparin-binding protein,HBP)和血管内皮细胞钙黏蛋白(Vascular endothelial-cadherin,VE-cadherin)的水平变化及其对预后的预测价值。方法 选取2019年2月-2021年本院收治的化脓性脑膜炎患儿106例[(Purulent meningitis,PM)组]和病毒性脑炎患儿75例[(Vascular endothelial,VE)组],同时选取60例在本院就诊的非感染性疾病患儿作为对照组; 比较3组患儿脑脊液HBP,VE-cadherin水平变化; 将PM组患儿依据出院时格拉斯哥预后评分(Glasgow outcome scale,GOS)标准分为预后良好组和预后不良组,对比预后良好组和预后不良组患儿脑脊液HBP,VE-cadherin水平以及其他可能的影响因素; 采用Logistic回归分析法明确影响化脓性脑膜炎患儿预后不良的危险因素; 绘制受试者工作特征(ROC)曲线,分析脑脊液HBP,VE-cadherin水平对化脓性脑膜炎患儿预后不良的预测价值。结果 入院第1 d PM组、VE组患儿脑脊液HBP,VE-cadherin水平均高于对照组(P<0.05); PM组患儿脑脊液HBP,VE-cadherin水平均高于VE组(P<0.05)。治疗后PM组与VE组患儿脑脊液HBP,VE-cadherin水平均低于入院第1 d(P<0.05),但2组治疗7 d后比较无明显差异(P>0.05)。单因素分析显示,预后不良组休克、意识障碍、脑脊液细菌培养阳性的占比、脑脊液白细胞计数(White blood cell,WBC)、C-反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)、HBP(入院第1 d与治疗7 d后)、VE-cadherin(入院第1 d与治疗7 d后)水平高于预后良好组(P<0.05)。经Logistic回归分析显示,休克、意识障碍、HBP(入院第1 d与治疗7 d后)、VE-cadherin(入院第1 d与治疗7 d后)水平均是化脓性脑膜炎患儿预后不良的危险因素(P<0.05)。受试者工作特征(Receiver operating characteristic,ROC)曲线分析显示,入院第1 d脑脊液HBP联合VE-cadherin水平预测化脓性脑膜炎患儿预后不良的灵敏度、准确度、曲线下面积(Areaunder the curve,AUC)分别为93.57%、92.16%、0.915,均高于脑脊液HBP,VE-cadherin单独预测; 治疗7 d后脑脊液HBP联合VE-cadherin水平预测化脓性脑膜炎患儿预后不良的灵敏度、准确度、曲线下面积(AUC)分别为96.89%、95.71%、0.931,均高于脑脊液HBP,VE-cadherin单独预测。结论 在化脓性脑膜炎患儿中脑脊液HBP,VE-cadherin水平异常升高,且是导致化脓性脑膜炎患儿预后不良的危险因素,对小儿化脓性脑膜炎的预后具有较高的预测价值。     

NSE含量变化对小儿颅内感染的临床意义

目的了解NSE在颅内感染患儿脑脊液和血清中的含量变化及对化脓性脑膜炎和病毒性脑膜炎的临床意义。方法采用电化学发光法测定NSE含量。结果脑脊液和血清中NSE水平均表现为化脓性脑膜炎明显高于病毒性脑膜炎,且均显著高于对照组（P〈0.01）,血清中NSE水平和脑脊液中NSE水平呈正相关。结论 NSE的检测对小人颅内感染的诊断有重要意义,NSE的含量越高,病人预后越差,即呈负相关。联合检测可提高检出的敏感性和准确性。     

头孢曲松钠联合地塞米松治疗小儿化脓性脑膜炎的临床分析

目的 分析药物治疗小儿化脓性脑膜炎的临床价值。方法 选择我院2017年3月至2019年7月内接诊的80例小儿化脓性脑膜炎患者，遵循药物差异分组原则分为对照组（38例，头孢曲松钠常规治疗）和观察组（42例，联合开展地塞米松治疗），观察两组在临床疗效、症状和体征恢复时间、治疗前后血清炎症因子水平改善情况以及用药安全性。结果 观察组的总有效率较对照组高（P<0.05）。治疗后观察组较对照组症状和体征恢复时间缩短（P<0.05）；住院时间也较对照组短（P<0.05）。治疗后观察组较对照组血清炎症因子各指标水平较低（P<0.05）。观察组的不良反应发生率较对照组低（P<0.05）。结论 头孢曲松钠常规治疗的基础上联合地塞米松治疗，提升了临床疗效，缩短了症状和体征恢复时间，降低了血清炎症因子水平，提高了临床用药安全性。     

成人颅内感染性疾病脑脊液检测指标变化的研究

目的观察成人颅内感染性疾病患者脑脊液中白介素-6(interleukin-6,IL-6)、超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、降钙素原(procalcitonin,PCT)、乳酸脱氢酶(lactic dehydrogenase,LDH)、腺苷脱氨酶(adenosine deaminase,ADA)、胆碱酯酶(cholinesterase,CHE)、谷草转氨酶(glutamic oxalacetic transaminase,AST/GOT)水平的变化,并探讨其临床意义。方法选取郑州大学第二附属医院2015-01—2018-06收治的120例患者,A组为30例化脓性脑膜炎患者,B组为28例病毒性脑膜炎患者,C组为22例结核性脑膜炎患者,D组为40例无颅内感染的患者。检测脑脊液IL-6、hs-CRP、PCT、LDH、ADA、CHE、AST水平,比较4组检测指标。结果 A、B、C组分别与D组相比,A组脑脊液hs-CRP、PCT、ADA水平明显高于D组,差异有统计学意义(P0. 05); B组脑脊液hs-CRP、PCT、ADA水平与D组相比,差异无统计学意义(P 0. 05); C组脑脊液ADA水平明显高于D组,差异有统计学意义(P0. 05); PCT、hs-CRP水平与D组相比,差异无统计学意义(P 0. 05); A、B、C组IL-6、LDH、CHE、AST水平均明显高于D组,差异有统计学意义(P0. 05)。结论成人化脓性脑膜炎患者脑脊液中IL-6、hs-CRP、PCT、LDH、ADA、CHE、AST水平明显升高,对化脓性脑膜炎患者具有较高的早期诊断价值; ADA可作为结核性脑膜炎的鉴别诊断指标。     

hs-CRP NO TNF-α及NSE对中枢神经系统感染的预测价值

目的观察和分析超敏C反应蛋白(hs-CRP)、一氧化氮(NO)、肿瘤坏死因子?α(TNF?α)及神经元特异性烯醇化酶(NSE)对中枢神经系统感染的预测价值。方法选取100例诊断为结核性脑膜炎(TBM)、隐球菌性脑膜炎(CM)、化脓性脑膜炎(PM)和病毒性脑膜炎(VM)的中枢神经系统感染性疾病患者为病例组,并根据病情分为重症组和非重症组,选取50例排除中枢神经系统感染性疾病的患者为对照组,对其脑脊液(CSF)中的hs-CRP、NO、TNF?α、NSE水平进行检测和比较。结果 PM患者CSF中的hs-CRP水平最高,其次为TBM患者和CM患者;TBM患者和PM患者CSF中的TNF?α水平最高,其次为CM和VM患者;VM患者CSF中的NSE水平最高,其次为TBM、CM和PM患者;PM患者CSF中的NO水平最高,其次为TBM、CM患者,差异均有统计学意义(q=2.736~3.927,P0.05);重症组患者CSF中的hs-CRP、TNF?α、NSE、NO水平均显著高于非重症组(t=2.764~3.622,P0.05),Logistic回归分析结果显示,重症中枢神经系统感染的发生与患者CSF中的TNF?α水平(OR=1.705)、NSE水平(OR=2.366)均具有相关性(P0.05)。结论中枢神经系统感染性疾病患者CSF中的hs-CRP、TNF?α、NO、NSE水平可作为病因鉴别诊断的辅助指标,而且TNF?α、NSE水平可用来辅助预测患者的病情严重程度。     

降钙素原在不同病原体感染脑膜炎中的临床价值

目的分析降钙素原(procalcitonin,PCT)在不同病原体感染脑膜炎中的临床价值。方法 103例急性脑膜炎患者在抗生素治疗前行腰穿检查,根据临床表现和脑脊液细胞学检查结果分成细菌性脑膜炎组和病毒性脑炎组。PCT、外周血CRP和血常规白细胞计数在入院和治疗后分别测定,采用化学发光免疫分析法检测103例急性脑膜炎患儿血清PCT及脑脊液PCT。结果治疗前细菌性脑膜炎组患者血清PCT浓度(15.36±7.25)ng/mL,脑脊液PCT浓度(0.91±0.32)ng/mL,病毒性脑膜炎组患者血清PCT浓度(0.88±0.42)ng/mL,脑脊液PCT浓度(0.23±0.11)ng/mL,2组比较差异均有统计学意义(P0.05)。经抗生素治疗后细菌性脑膜炎组患儿血清PCT浓度(6.78±3.45)ng/mL,明显低于治疗前,差异有统计学意义(P0.05)。结论降钙素原对鉴别细菌性脑膜炎和病毒性脑膜炎具有重要的临床价值,同时也可作为细菌性脑膜炎的疗效指标。     

中枢神经系统感染患者脑脊液乳酸和神经元特异性烯醇化酶浓度的临床价值

目的通过观察中枢神经系统感染患者脑脊液乳酸(LA)和神经元特异性烯醇化酶(NSE)浓度,以鉴别病毒性脑膜炎(病脑)、化脓性脑膜炎(化脑)、结核性脑膜炎(结脑)。方法选取住院的中枢神经系统感染患者85例,其中化脑组25例、结脑组26例、病脑组34例。30例外科手术患者为对照组。用酶显色法测定脑脊液LA浓度;用ELISA法测定脑脊液NSE浓度。结果化脑组和结脑组患者脑脊液乳酸浓度明显高于病脑组和对照组(分别为P0.01和P0.05),其浓度依次为化脑组结脑组病脑组对照组,但化脑组与结脑组及病脑组与对照组脑脊液LA浓度比较差异无统计学意义(P0.05);病脑组、结脑组患者脑脊液NSE浓度均明显高于化脑组和对照组(P0.01),其浓度依次为病脑组结脑组化脑组对照组,但病脑组与结脑组及化脑组与对照组脑脊液NSE水平比较差异无统计学意义(P0.05)。结论脑脊液LA和NSE浓度检测有助于病脑、化脑和结脑间的临床鉴别诊断。     

小儿脑膜炎患者脑脊液IGF-Ⅱ IGFBP-3水平的测定及意义

目的测定小儿脑膜炎患者脑脊液中胰岛素样生长因子Ⅱ(IGF?Ⅱ)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平变化,探讨其临床意义,为疾病鉴别诊断提供依据。方法选取2006-03—2014-03于我院儿科收治的脑膜炎患儿75例为研究对象,化脓性脑膜炎25例,病毒性脑膜炎25例,结核性脑膜炎25例,另选取于我院同期进行体检的健康儿童25例为对照组。对所有研究对象进行腰椎穿刺术提取脑脊液,用于脑脊液生化检测,观察并比较小儿脑脊液中IGF?Ⅱ、IGFBP-3水平变化情况。结果与对照组比较,化脓性脑膜炎组、病毒性脑膜炎组、结核性脑膜炎组患儿脑脊液IGF?Ⅱ、IGFBP-3水平均明显升高,差异均具有统计学意义(P0.05);经治疗后,化脓性脑膜炎组、病毒性脑膜炎组、结核性脑膜炎组患儿脑脊液IGF?Ⅱ、IGFBP-3水平较治疗前明显下降,差异具有统计学意义(P0.05);化脓性脑膜炎组与对照组、病毒性脑膜炎组、结核性脑膜炎组比较,差异具有统计学意义(P0.05)。结论对小儿脑膜炎患者进行脑脊液IGF?Ⅱ、IGFBP-3水平的测定,能够为不明类型的脑膜炎鉴别诊断提供依据。     

Fasciitis, perimyositis, myositis, polymyositis, and eosinophilia

Several groups of cases of fasciitis and myositis with eosinophilia are reported. The common features are inflammation into fascia and/or perimysium, and/or muscle fibers; eosinophilia in blood and/or in muscle biopsy. The following classification of 24 cases is suggested: at one end of the spectrum are fasciitis with eosinophilia: diffuse fasciitis (Shulman syndrome): 10 cases (3 with hematological complications); 2 cases of diffuse fasciitis with muscle atrophy; 3 cases of restricted fasciitis. Relapsing perimyositis with eosinophilia belong to the same spectrum, either diffuse (5 cases) with myalgias, or localized (2 cases). Other cases are focal myositis or multiple myositis, polymyositis with eosinophilia. The relationship among these cases is discussed. There is a continuum among the different groups. The pathophysiology remains unknown.     

Diphenylhydantoin, Phenobarbital, and Primidone in Saliva, Plasma, and Cerebrospinal Fluid

Diphenylhydantoin, primidone, and phenobarbital were determined in saliva and plasma of 164 patients by gas-liquid chromatography. The saliva ratio was about one-tenth in patients on diphenylhydantoin, 0.32-0.38 on phenobarbital alone and with other drugs, 0.97 and 0.96 on primidone alone and with other drugs. The S/P ratio of phenobarbital was similar in patients treated with primidone alone or with co-medication. For diphenylhydantoin and primidone, the S/P and CSF/plasma ratio were similar; for phenobarbital the S/P ratio was lower due to the difference in pH of saliva and CSF. Thus the concentration in saliva serves as a measure of the nonprotein-bound or free concentration in plasma with the advantage that saliva is easy to obtain. Co-medication does not change the S/P ratio for the three drugs studied. The high correlation between levels in plasma and in saliva allows the plasma levels to be predicted from the concentration in saliva.     

Caspases, apoptosis, and Alzheimer disease: causation, correlation, and confusion

Extensive neuron loss occurs in Alzheimer disease (AD) brain and some authors have speculated that dysregulation of apoptotic death pathways is etiologically responsible for the disease. Apoptosis is regulated in mammalian cells by a family of cysteine proteases called caspases. At least 7 different caspases (caspases 1, 2, 3, 6, 8, 9, and 12) have been implicated in regulating neuronal cell death in response to amyloid beta (A beta) exposure in vitro, in animal models of neurodegenerative diseases, and in AD brain itself. Despite this seemingly impressive array of data implicating caspases and apoptosis as etiologic factors in AD, the direct involvement of caspase-dependent neuronal apoptosis in AD pathogenesis remains uncertain. Alternative explanations for some findings, contradictory experimental observations, and lack of morphologically convincing apoptotic neurons in the vast majority of AD brains has led to the revised hypothesis that apoptosis-associated molecular events cause neuronal dysfunction in the absence of, or prior to, neuronal death. Unfortunately, this new view renders the term "apoptosis-associated" functionally meaningless since it bears no relationship with apoptotic death and fails to focus scientific investigation on the molecular insults that trigger the "apoptosis-associated" response in AD neurons. On balance, an etiologic role for caspases in AD is far from proven. It remains possible, however, that caspase-dependent neuronal death contributes to AD neuron loss and thus, caspase inhibition offers some hope for extending AD neuron survival so that other agents, targeting upstream events, may delay or reverse primary AD pathology.     

Head size and intelligence, learning, nutritional status and brain development. Head, IQ, learning, nutrition and brain

This multifactorial study investigates the interrelationships between head circumference (HC) and intellectual quotient (IQ), learning, nutritional status and brain development in Chilean school-age children graduating from high school, of both sexes and with high and low IQ and socio-economic strata (SES). The sample consisted of 96 right-handed healthy students (mean age 18.0 +/- 0.9 years) born at term. HC was measured both in the children and their parents and was expressed as Z-score (Z-HC). In children, IQ was determined by means of the Wechsler Intelligence Scale for Adults-Revised (WAIS-R), scholastic achievement (SA) through the standard Spanish language and mathematics tests and the academic aptitude test (AAT) score, nutritional status was assessed through anthropometric indicators, brain development was determined by magnetic resonance imaging (MRI) and SES applying the Graffar modified method. Results showed that microcephalic children (Z-HC < or = 2 S.D.) had significantly lower values mainly for brain volume (BV), parental Z-HC, IQ, SA, AAT, birth length (BL) and a significantly higher incidence of undernutrition in the first year of life compared with their macrocephalic peers (Z-HC > 2S.D.). Multiple regression analysis revealed that BV, parental Z-HC and BL were the independent variables with the greatest explanatory power for child's Z-HC variance (r(2) = 0.727). These findings confirm the hypothesis formulated in this study: (1) independently of age, sex and SES, brain parameters, parental HC and prenatal nutritional indicators are the most important independent variables that determine HC and (2) microcephalic children present multiple disorders not only related to BV but also to IQ, SA and nutritional background.