急性中枢神经系统感染患儿脑脊液中IL-6和TNF水平的测定及临床意义

目的　探讨急性中枢神经系统感染患儿脑脊液 (CSF)中白细胞介素 - 6 (IL - 6 )和肿瘤坏死因子(TNF)水平的变化及临床意义。方法　采用ELISA法对 5 0例初诊为中枢神经系统感染患儿 ,其中化脓性脑膜炎(PM ) 1 8例 ,病毒性脑膜脑炎 (VE) 32例 ,进行了CSF中IL - 6和TNF水平测定 ,并与 1 2例对照组测定值进行比较。结果　PM组患儿CSF中IL - 6和TNF水平 (分别为 746± 499pg/ml和 5 6 5± 371 pg/ml)明显高于VE组 (分别为 1 6 5± 1 76 pg/ml和 75± 73pg/ml)和对照组 (分别 1 0± 1 7pg/ml和 2 1± 2 6pg/ml) (均 P <0 .0 0 1 ) ,VE组CSF中IL - 6和TNF水平亦明显高于对照组 (分别P <0 .0 1和P <0 .0 5 )。患儿CSF中IL - 6和TNF水平与脑脊液白细胞计数之间相关性分析 ,未见显著性意义。结论　IL - 6和TNF参与了急性中枢神经系统感染的病理生理过程 ,CSF中IL - 6和TNF的测定可能对化脓性脑膜炎和病毒性脑膜脑炎的鉴别具有一定的意义。

Determination of Interleukin-6 and Tumor Necrosis Factor in Cerebrospinal Fluid in Children with Acute Infection of the Central Nervous System

Objective To study the changes of interleukin 6 (IL 6) and tumor necrosis factor (TNF) levels in cerebrospinal fluid (CSF) in children with acute infection of the central nervous system. Methods IL 6 and TNF in CSF were determined using ELISA in 50 children who were admitted with acute infection of the central nervous system, including 18 cases with purulent meningitis (PM) and 32 cases with viral meningitis or encephalitis (VE), and twelve children served as controls. Results The levels of IL 6 and TNF in the PM group (746±499 pg/ml and 565±371 pg/ml, respectively) were significantly higher than that of the VE group (165±176 pg/ml and 75±73 pg/ml, respectively) and the controls (10±17 pg/ml and 21±26 pg/ml, respectively) (P<0.001). The levels of IL 6 and TNF in the VE group were also higher than those of the controls (P<0.01 and P<0.05, respectively). No significant relationship was found between elevations of CSF IL 6 and TNF levels and CSF leukocyte counts. Conclusions The determination of CSF IL 6 and TNF levels may be valuable in distinguishing purulent meningitis from viral meningitis and encephalitis. We speculate that IL 6 and TNF may contribute to the pathophysiological mechanisms of acute infection of the central nervous system.