化脓性脑膜炎、病毒性脑炎患儿血清降钙素原 和基质金属蛋白酶9 的变化研究

Serum levels of procalcitonin and MMP-9 in children with purulent meningitis and viral encephalitis

摘要:

目的 探讨血清降钙素原（PCT）、基质金属蛋白酶9（MMP-9）在化脓性脑膜炎、病毒性脑炎中 的临床诊断价值。方法 选择化脓性脑膜炎患儿20 例（化脑组），病毒性脑炎患儿31 例（病脑组）作为研究对象， 非感染性无热惊厥患儿20 例作为对照组。采用电化学发光法测定血清PCT 浓度，双抗体夹心法酶联免疫吸附 实验（ELISA）检测血清MMP-9 水平。结果 3 组血清PCT、MMP-9 水平比较，差异有统计学意义（P <0.05）； 化脑组血清PCT 水平高于对照组、病脑组（P =0.001 和0.003），病脑组PCT 水平与对照组比较差异无统计学 意义（P =0.851）；化脑组血清MMP-9 水平高于对照组和病脑组（P =0.005 和0.009），病脑组较对照组亦升 高（P =0.007）。化脑组血清PCT 异常升高率高于病脑组，差异有统计学意义（χ2=68.210，P =0.000），而血 清MMP-9 异常升高率两组间比较，差异无统计学意义（χ2=0.252，P =0.833）。经直线相关分析，化脑组血 清PCT、MMP-9 浓度与血白细胞（WBC）、C 反应蛋白（CRP）、脑脊液WBC、脑脊液清蛋白呈正相关，与 脑脊液葡萄糖浓度呈负相关（P <0.05），与脑脊液氯化物水平无相关性（P >0.05），PCT 和MMP-9 血清水平呈 正相关（r =0.694，P <0.05）；病脑组血清PCT 与血WBC、CRP 以及脑脊液WBC、脑脊液清蛋白、葡萄糖、 脑脊液氯化物水平均无相关性（P >0.05），MMP-9 与脑脊液清蛋白水平呈正相关（P <0.05），与血WBC、 CRP 以及脑脊液WBC、葡萄糖、氯化物水平均无相关性（P >0.05），PCT 和MMP-9 血清水平无相关性 （r =0.044，P >0.05）。结论 化脑组血清PCT、MMP-9 水平均明显升高，而病脑组仅MMP-9 水平升高，检 测PCT、MMP-9 血清浓度对化脓性脑膜炎、病毒性脑炎的诊断、鉴别诊断具有重要的临床意义。

Abstract:

Objective To study the diagnostic value of serum levels of procalcitonin (PCT) and matrix metalloproteinase 9 (MMP-9) in children with purulent meningitis and viral encephalitis. Methods Twenty children with purulent meningitis were selected as purulent meningitis group, 31 patients with viral encephalitis as viral encephalitis group, and 20 non-infectious convulsion children as control group. The serum PCT 1evels were measured by electrochemiluminescence immunoassay, and serum MMP-9 levels were detected by enzyme-linked immunosorbent assay. Results The mean serum level of PCT in the purulent meningitis group was significantly higher than that in the viral encephalitis group and the control group (P = 0.001 and 0.003), however, there was no significant difference between the viral encephalitis group and the control group (P = 0.851). The mean serum level of MMP-9 in the purulent meningitis group was significantly higher than that in the viral encephalitis group and the control group (P = 0.005 and 0.009), and the MMP-9 level in the viral encephalitis group was significantly higher than that in the control group (P = 0.007). The rate of abnormal increase of serum PCT in the purulent meningitis group was significantly higher than that in the viral encephalitis group (χ2 = 68.210, P = 0.000), but there was no significant difference in the rate of abnormal increase of serum MMP-9 between the two groups (χ2 = 0.252, P = 0.833). In the purulent meningitis group, serum PCT and MMP-9 levels were positively correlated with white blood cell (WBC) count and C-reactive protein (CRP) in blood, WBC count and protein levels in cerebrospinal fluid (CSF) (P < 0.05), and negatively correlated with the CSF glucose (P < 0.05), but not correlated with chloride in CSF; and serum PCT level was positively correlated with serum MMP-9 level (r = 0.694, P < 0.05). In the viral encephalitis group, serum PCT level had no correlation with serum WBC, serum CRP, CSF WBC count, protein, glucose or chloride level (P > 0.05); serum MMP-9 level had a positive correlation with CSF protein level (P < 0.05), but no correlation with serum WBC, serum CRP, CSF WBC count, glucose or chloride level (P > 0.05); serum PCT level was not correlated with serum MMP-9 level either (r = 0.044, P > 0.05). Conclusions Both serum PCT and MMP-9 levels significantly increase in purulent meningitis children, while only serum MMP-9 level increases significantly in viral encephalitis patients. Detection of serum PCT and MMP-9 levels is valuable in the diagnosis and differential diagnosis of purulent meningitis and viral encephalitis.