小儿结核性脑膜炎外周血补体因子 H、载脂蛋白A1和淀粉样蛋白A表达水平变化及其临床意义

目的 探讨小儿结核性脑膜炎(Tuberculous meningitis, TBM)外周血补体因子H(Complement factor H,CFH)、载脂蛋白A1(Apolipoprotein AI,ApoAI)和淀粉样蛋白A(Serum amyloid A,SAA)表达水平变化，分析其与TBM病情和预后的关系。方法 选择2017年3月-2021年1月本院收治的112例TBM患儿，根据英国医学研究理事会(Medical research council, MRC)分期标准分为Ⅰ期组(37例)、Ⅱ期组(46例)、Ⅲ期组(29例),根据改良Rankin量表(Modified Rankin Scale, mRS)评分将患儿分为预后良好组(0～2分，62例),预后不良组(≥3分，50例)。另选择71例健康儿童为对照组；检测血清CFH,ApoAI,SAA水平，分析其与TBM病情以及预后的关系。结果 TBM组血清CFH,SAA水平均高于对照组(P<0.05),ApoAI水平低于对照组(P<0.05);重度组血清CFH,SAA水平高于中度组和轻度组(P<0.05),ApoAI水平...

The expression levels of peripheral blood complement factor H,apolipoprotein A1 and amyloid A in children with tuberculous meningitis and their clinical significance

Objective To investigate the expression of complement factor H (CFH), apolipoprotein A1 (Apo AI), and amyloid A (SAA) in peripheral blood of children with tuberculous meningitis (TBM), and to analyze their relationship with the prognosis of TBM. Methods 112 children with TBM admitted to our hospital from March 2017 to January 2021 were divided into stage Ⅰ group (37 cases), Stage Ⅱ group (46 cases), and Stage Ⅲ group (29 cases) according to the British Medical Research Council (MRC) staging criteria. According to the modified Rankin scale (mRS) score, the children were divided into the good prognosis group (0-2 points,62 cases), and the poor prognosis group (≥3 points,50 cases).Another 71 healthy children were selected as the control group. Serum CFH, Apo AI and SAA levels were detected, and their relationship with disease severity and prognosis was analyzed.Results The serum CFH and SAA levels in the TBM group were higher than those in the control group (P < 0.05), while the serum Apo AI levels in the TBM group were lower than those in the control group (P< 0.05). The serum CFH and SAA levels in the severe group were higher than those in the moderate and mild groups (P < 0.05). The serum Apo AI levels were lower than those in moderate and mild groups (P< 0.05).MRC stage Ⅲ, high level of CFH, and SAA were risk factors for poor prognosis in TBM patients (P< 0.05). High level of Apo AI was a protective factor for poor prognosis in TBM patients (P< 0.05).CFH, Apo AI, SAA predicted poor prognosis of TBM patients with under the curve area of 0.613, 0.610, and 0.592, respectively. The area under the curve of combined CFH, Apo AI, and SAA is 0.855, higher than that of CFH, Apo AI, SAA alone (z =6.275, 5.936, 6.569, P< 0.05).Conclusion The serum CFH and SAA levels are increased, while the Apo AI levels are decreased in children with TBM, which was related to the aggravation of the disease and poor prognosis.