脑脊液热休克蛋白70水平对小儿中枢神经系统感染的鉴别诊断价值

目的 探讨脑脊液(CSF)中热休克蛋白70(HSP70)的变化及其在小儿中枢神经系统感染中的诊断价值.方法 采用蛋白质免疫印迹技术检测13例化脓性脑膜炎(化脑组)、38例病毒性脑膜炎(病脑组)、7例结核性脑膜炎(结脑组)及46例非中枢神经系统感染患儿(对照组)CSF中HSP70水平.常规生化检测CSF的细胞总数、白细胞数、乳酸脱氢酶(LDH)、蛋白定量、腺苷脱氨酶、葡萄糖、压力及氯(Cl-) 水平.结果 化脑组(76.61±27.69)、病脑组(33.65±16.93)及结脑组(65.85±33.16)的HSP70水平均高于对照组(23.28±19.77),差异有显著性(P＜0.05或P＜0.01);化脑组及结脑组HSP70水平均高于病脑组(P均＜0.01);化脑组与结脑组之间HSP70水平差异无显著性(P＞0.05).相关性分析显示:HSP70水平增高程度与CSF的细胞总数(r=0.298,P=0.002)、白细胞数(r=0.274,P=0.005)、LDH(r=0.322,P=0.001)、蛋白定量(r=0.629,P＜0.001)、腺苷脱氨酶水平(r=0.363,P=0.001)均呈显著正相关,与CSF中葡萄糖水平呈显著负相关(r=-0.443,P＜0.001),与CSF压力(r=0.001,P=0.993)及Cl-水平(r=0.148,P=0.133)无相关性.结论 小儿中枢神经系统感染时,CSF中HSP70增高;检测CSF中HSP70水平有助于化脑、结脑与病脑的鉴别诊断.

Significance of heat shock protein 70 in cerebrospinal fluid in differential diagnosis of central nervous system infection in children

OBJECTIVE: To investigate the diagnostic value of heat shock protein 70 (HSP70) in central nervous system infection (CNSI) in children. METHODS: The level of HSP70 in the cerebrospinal fluid (CSF) was determined in children with CNSI of different etiology. The concentration of HSP70 was determined in the CSF of 104 children, among them 13 patients had purulent meningitis (PM), 38 patients had acute viral meningitis (VM), 7 patients had tuberculous meningitis (TM), and 46 with no CNSI to serve as controls. The concentration of HSP70 was determined by Western blotting assay. The CSF specimens were also analyzed for the total cellular score (TCS), white blood cell count (WBC), lactate dehydrogenase (LDH), protein content (PC), adenosine deaminase (ADD), glucose, chloride content (Cl(í)), and pressure. RESULTS: The CSF level of HSP70 was significantly higher in the PM, TM and VM groups 76.61+/-27.69, 65.85+/-33.16, 33.65+/-16.93] compared with the control group (23.28+/-19.77) (P<0.05 or P<0.01). The HSP70 concentration was markedly higher in the CSF of patients with PM and TM than patients with VM (both P<0.01). No significant difference was found between PM group and TM group in HSP70 level in CSF (P>0.05). The concentration of HSP70 in the CSF was positively correlated to TCS (r=0.298, P=0.002), WBC (r=0.274, P=0.005), LDH (r=0.322, P=0.001), PC (r=0.629, P<0.001), ADD (r=0.363, P<0.001), and negatively correlated to the glucose (r=-0.443, P<0.001) in CSF. The HSP70 concentration was not correlated to the Cl(í) (r=0.148, P=0.133) and pressure (r=0.001, P=0.993) of CSF. CONCLUSION: HSP70 is increased in the CSF of patients with CNSI. It may be one of the pathophysiological mechanisms of acute infection of the central nervous system. The level of HSP70 in CSF may be a valuable index in the differential diagnosis of CNSI, and it may be helpful in differentiating PM and TM from VM.