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。

Changes of HBP and VE-cadherin in cerebrospinal fluid in children with purulent meningitis and their prognostic values

Objective To study the changes of heparin binding protein(HBP) and vascular endothelial cell cadherin(VE-cadherin) in cerebrospinal fluid in children with purulent meningitis and their prognostic values. Methods We selected 106 cases of children with purulent meningitis(PM Group), 75 cases of children with viral encephalitis(VE), and 60 cases in children with non-infectious diseases as the control group from February 2019 to 2021 inthehospital. The changes of HBP and VE-cadherin levels in the cerebrospinal fluid of the three groups were compared. The children in the PM group were divided into a good prognosis group and a poor prognosis group according to the Glasgow Outcome Score(GOS) at the time of discharge. The HBP and VE-cadherin levels in the cerebrospinal fluid of children in the good prognosis group and the poor prognosis group were compared with other possible influencing factors. Logistic regression analysis was used to determine the risk factors that affect the prognosis of children with purulent meningitis. Receiver operating characteristic(ROC) curve was drew to analyze the predictive value of HBP and VE-cadherin in the cerebrospinal fluid. Results On the first day of admission, the levels of HBP and VE-cadherin in the PM and VE groups were higher than those in the control group(P<0.05), and the levels of HBP and VE-cadherin in the PM group were higher than those in the VE group(P<0.05). After treatment, the levels of HBP and VE-cadherin of children in PM group and VE group decreased(P<0.05). There was no significant difference between the two groups(P>0.05). Univariate analysis found that the proportion of shock, disturbance of consciousness, and positive cerebrospinal fluid bacterial culture in the poor prognosis group, the levels of WBC, CRP, PCT, HBP(on the first day of admission and after treatment), VE-cadherin(on the first day of admission and after treatment) in the cerebrospinal fluid was higher than that of the good prognosis group(P<0.05). According to logistic regression analysis, shock, consciousness disturbance, HBP(on the first day of admission and after treatment), and VE-cadherin(on the first day of admission and after treatment) are the risk factors of prognosis(P<0.05). ROC curve analysis showed that the sensitivity, accuracy and area under the curve(AUC) of cerebrospinal fluid HBP combined with VE-cadherin in predicting the poor prognosis of children with purulent meningitis were 93.57%, 92.16% and 0.915, respectively, which were higher than those of cerebrospinal fluid HBP and VE-cadherin alone on the first day of admission. After treatment, the sensitivity, accuracy and area under the curve(AUC) of HBP combined with VE-cadherin in predicting the poor prognosis of children with purulent meningitis were 96.89%, 95.71% and 0.931, respectively, which were higher than those of cerebrospinal fluid HBP and VE-cadherin alone. Conclusion The levels of cerebrospinal fluid HBP and VE-cadherin are elevated in children with purulent meningitis. They can serve as good indicators for the predictive prognosis of purulent meningitis.