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中枢神经系感染是小儿常见病和多发病,尤其以病毒性脑炎多见,严重的患儿会遗留不同程度的中枢神经系统损伤, 对日后的生活及学习能力产生严重影响,因此早期诊断和治疗非常重要。研究[1]显示脑脊液基质金属蛋白酶(MMPs)可改变血脑屏障通透性,增加致病菌或其他有害物质对脑组织损害风险,在病毒性脑炎的发生和发展过程中起到了关键的作用。本研究将临床收治的病毒性脑炎患儿,根据脑脊液检验结果分为脑脊液异常组和脑脊液正常组,留取急性期(入院72 h内)和恢复期(治疗1周后)的脑脊液和静脉血,检测MMP-2和MMP-9水平,通过与脑脊液细胞数相关性分析,来判断脑脊液和静脉血MMPs数值对临床诊断的影响。现作报道。
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2组年龄、性别、血常规、生化常规、CRP等一般资料差异无统计学意义(P>0.05),2组脑脊液中的白细胞数和乳酸差异均有统计学意义(P < 0.01)。且2组住院时间差异亦有统计学意义(P < 0.05)。而进一步对脑脊液和外周血中的MMPs蛋白分析发现,2组外周血和脑脊液中的MMP-2、MMP-9差异均有统计学意义(P < 0.05~P < 0.01)(见表 1)。
一般资料 脑脊液异常组
(n=20)脑脊液正常组
(n=20)t P 年龄/岁 5.75±3.37 5.46±4.97 0.22 >0.05 男 13 10 0.92# >0.05 脑脊液白细胞数/(个/毫升) 82.20±61.55 3.35±3.15 5.72 < 0.01 脑脊液乳酸/(mmol/L) 1.81±0.55 1.34±0.27 3.43* < 0.01 脑脊液白蛋白/(g/L) 0.36±0.21 0.32±0.30 0.49 >0.05 体温/℃ D1 37.93±0.85 37.80±1.16 0.40 >0.05 D2 37.71±0.84 37.52±0.88 0.70 >0.05 D3 37.22±0.55 37.11±0.49 0.67 >0.05 降钙素原/(ng/mL) 0.23±0.27 0.45±0.63 1.02 >0.05 CRP/(mg/L) 6.54±9.59 16.40±21.30 1.89 >0.05 外周血白蛋白/(g/L) 41.72±2.62 40.46±5.31 0.95* >0.05 血肌酐/(μmol/L) 39.79±10.78 35.00±12.94 1.27 >0.05 血尿素氮/(mmol/L) 3.33±0.94 3.74±1.03 1.31 >0.05 丙氨酸氨基转移酶/(U/L) 18.85±8.23 23.20±14.98 1.14* >0.05 天门冬氨酸氨基转移酶/(U/L) 36.65±26.95 36.10±17.34 0.08 >0.05 住院时间/d 16.45±13.61 9.10±3.31 2.35* < 0.05 外周血MMP-2/(μg/L) 871.80±137.69 675.30±143.08 4.43 < 0.01 外周血MMP-9/(μg/L) 245.35±52.36 202.05±52.49 2.61 < 0.05 脑脊液MMP-2/(μg/L) 103.70±13.15 72.15±14.17 7.30 < 0.01 脑脊液MMP-9/(μg/L) 74.15±7.58 52.30±8.57 8.54 < 0.01 *示t′值;#示χ2值 表 1 2组一般资料比较(x±s)
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结果显示, 外周血中的MMP-2、MMP-9和脑脊液WBC呈明显正相关关系(r=0.732、0.695, P < 0.01)。脑脊液MMP-2、MMP-9和脑脊液WBC呈明显正相关关系(r=0.827、0.775, P < 0.01)。
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外周血中的MMP-2、MMP-9对脑脊液细胞数的灵敏度和特异度分析显示,ROC曲线下面积(AUC)分别为0.860和0.725(P < 0.01和P < 0.05);脑脊液MMP-2、脑脊液MMP-9对脑脊液细胞数的灵敏度和特异度分析显示,AUC分别为0.950和0.980(P < 0.01)(见表 2、图 1)。
指标 AUC P 灵敏度 特异度 cutoff值 阳性预测值/% 阴性预测值/% 外周血 MMP-2 0.860 < 0.01 0.75 0.90 778.5 88.24 78.26 MMP-9 0.725 < 0.05 0.60 0.85 252.0 80.00 68.00 脑脊液 MMP-2 0.950 < 0.01 0.90 0.85 97.0 92.86 73.08 MMP-9 0.980 < 0.01 0.90 0.95 65.5 94.74 90.48 表 2 外周血和脑脊液中MMP2/MMP-9对脑脊液细胞数的灵敏度和特异度分析
基质金属蛋白酶水平对病毒性脑炎患儿早期诊断的临床价值
Clinical value of the matrix metalloproteinase level in early diagnosis of viral encephalitis in children
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摘要:
目的通过分析病毒性脑炎患儿脑脊液和血清基质金属蛋白酶(MMPs)水平与脑脊液白细胞的相关性来预测MMPs在病毒性脑炎早期诊断的价值。 方法选择确诊为病毒性脑炎的住院患儿40例,通过ELISA法检测脑脊液细胞数异常患儿(20例)和脑脊液细胞数正常患儿(20例)血清和脑脊液中MMP-2和MMP-9水平。 结果2组外周血和脑脊液中的MMP-2、MMP-9差异有统计学意义(P < 0.05~P < 0.01)。外周血中的MMP-2、MMP-9和脑脊液白细胞数呈明显正相关关系(P < 0.01)。脑脊液中的MMP-2、MMP-9和脑脊液白细胞数亦呈明显正相关关系(P < 0.01)。外周血中的MMP-2、MMP-9对脑脊液细胞数的灵敏度和特异度分析显示,曲线下面积分别为0.860和0.725(P < 0.01和P < 0.05);脑脊液中的MMP-2、MMP-9对脑脊液细胞数的灵敏度和特异度分析显示,曲线下面积分别为0.950和0.980(P < 0.01)。 结论外周血的MMP-2、MMP-9水平可以反映脑脊液中MMP-2、MMP-9水平,可以作为病毒性脑炎的生物标志物,成为早期诊断的预测因子。 Abstract:ObjectiveTo predict the value of matrix metalloproteinases(MMPs) in the early diagnosis of viral encephalitis by analyzing the correlation between the serum levels of MMPs and white blood cells in cerebrospinal fluid(CSF) of children with viral encephalitis. MethodsForty hospitalized children with viral encephalitis were selected.The serum and CSF levels of MMP-2 and MMP-9 were detected by ELISA in 20 children with abnormal CSF cell count and 20 children with normal CSF cell count. ResultsThe differences of the levels of MMP-2 and MMP-9 in peripheral blood and CSF between two groups were statistically significantly(P < 0.05 to P < 0.01).The serum levels of MMP-2 and MMP-9 in peripheral blood were positively correlated with the number of white blood cells in CSF(P < 0.01).The levels of MMP-2 and MMP-9 in CSF were positively correlated with the number of white blood cells in CSF(P < 0.01).The sensitivity and specificity of MMP-2 and MMP-9 in peripheral blood to the number of CSF cells showed that the area under the curve was 0.860 and 0.725, respectively(P < 0.01 and P < 0.05).The sensitivity and specificity analysis of MMP-2 and MMP-9 in CSF to the number of CSF cells showed that the area under the curve was 0.950 and 0.980, respectively(P < 0.01). ConclusionsThe levels of MMP-2 and MMP-9 in peripheral blood can reflect the concentrations of MMP-2 and MMP-9 in CSF, which can be used as biomarkers of viral encephalitis and predictors of early diagnosis. -
Key words:
- viral encephalitis /
- matrix metalloproteinases /
- cerebrospinal fluid
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表 1 2组一般资料比较(x±s)
一般资料 脑脊液异常组
(n=20)脑脊液正常组
(n=20)t P 年龄/岁 5.75±3.37 5.46±4.97 0.22 >0.05 男 13 10 0.92# >0.05 脑脊液白细胞数/(个/毫升) 82.20±61.55 3.35±3.15 5.72 < 0.01 脑脊液乳酸/(mmol/L) 1.81±0.55 1.34±0.27 3.43* < 0.01 脑脊液白蛋白/(g/L) 0.36±0.21 0.32±0.30 0.49 >0.05 体温/℃ D1 37.93±0.85 37.80±1.16 0.40 >0.05 D2 37.71±0.84 37.52±0.88 0.70 >0.05 D3 37.22±0.55 37.11±0.49 0.67 >0.05 降钙素原/(ng/mL) 0.23±0.27 0.45±0.63 1.02 >0.05 CRP/(mg/L) 6.54±9.59 16.40±21.30 1.89 >0.05 外周血白蛋白/(g/L) 41.72±2.62 40.46±5.31 0.95* >0.05 血肌酐/(μmol/L) 39.79±10.78 35.00±12.94 1.27 >0.05 血尿素氮/(mmol/L) 3.33±0.94 3.74±1.03 1.31 >0.05 丙氨酸氨基转移酶/(U/L) 18.85±8.23 23.20±14.98 1.14* >0.05 天门冬氨酸氨基转移酶/(U/L) 36.65±26.95 36.10±17.34 0.08 >0.05 住院时间/d 16.45±13.61 9.10±3.31 2.35* < 0.05 外周血MMP-2/(μg/L) 871.80±137.69 675.30±143.08 4.43 < 0.01 外周血MMP-9/(μg/L) 245.35±52.36 202.05±52.49 2.61 < 0.05 脑脊液MMP-2/(μg/L) 103.70±13.15 72.15±14.17 7.30 < 0.01 脑脊液MMP-9/(μg/L) 74.15±7.58 52.30±8.57 8.54 < 0.01 *示t′值;#示χ2值 表 2 外周血和脑脊液中MMP2/MMP-9对脑脊液细胞数的灵敏度和特异度分析
指标 AUC P 灵敏度 特异度 cutoff值 阳性预测值/% 阴性预测值/% 外周血 MMP-2 0.860 < 0.01 0.75 0.90 778.5 88.24 78.26 MMP-9 0.725 < 0.05 0.60 0.85 252.0 80.00 68.00 脑脊液 MMP-2 0.950 < 0.01 0.90 0.85 97.0 92.86 73.08 MMP-9 0.980 < 0.01 0.90 0.95 65.5 94.74 90.48 -
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