单独及联合检测脑脊液中3种标志物对儿童病毒性脑炎与不典型化脓性脑炎的鉴别诊断价值  

Value of single and joint detection of three markers in the differentiation of viral encephalitis and atypical purulent encephalitis in children

作　　者：李轲[1] 谢付静[2] 杨亚培[1] 王鲁卿[3] LI Ke;XIE Fu-jing;YANG Ya-pei;WANG Lu-qing(Central Laboratory, Liaocheng People＇s Hospital, Liaocheng 252000, Chin)

机构地区：[1]聊城市人民医院中心实验室,山东聊城252000 [2]聊城市人民医院儿科,山东聊城252000 [3]聊城市人民医院核医学科放免室,山东聊城252000

出　　处：《中华实用诊断与治疗杂志》2018年第4期375-377,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：中国博士后科学基金面上项目(2013M531617)

摘　　要：目的探讨脑脊液神经特异性烯醇化酶(neuro-specific enolase,NSE)、新喋呤(neopterin,NPT)及中枢神经特异蛋白(specific protein 100β,S100β)水平对鉴别儿童病毒性脑炎和不典型化脓性脑炎的价值。方法 56例中枢神经系统感染患儿,其中32例病毒性脑炎患儿为病毒性脑炎组,24例不典型化脓性脑炎患儿为化脓性脑炎组;同期经腰椎穿刺检查证实无神经系统损伤患儿26例为对照组。采用电化学发光法测定3组患儿脑脊液NSE、S100β水平,采用ELISA法测定3组患儿脑脊液NPT水平,并进行组间比较;绘制ROC曲线图,评价3项指标单独及联合检测对儿童病毒性脑炎与不典型化脓性脑炎的诊断价值。结果病毒性脑炎组患儿脑脊液NPT水平[(70.86±15.42)nmol/L]高于化脓性脑炎组[(28.24±7.23)nmol/L]和对照组[(25.64±6.18)nmol/L](P<0.05),化脓性脑炎组与对照组比较差异无统计学意义(P>0.05);病毒性脑炎组、化脓性脑炎组患儿脑脊液S100β[(1.025±0.380、0.936±0.290)μg/L]、NSE水平[(29.64±6.38)、(18.55±5.72)μg/L)高于对照组[(0.370±0.110)μg/L、(9.87±3.46)μg/L](P<0.05),病毒性脑炎组NSE水平高于化脓性脑炎组(P<0.05),S100β水平与化脓性脑炎组比较差异无统计学意义(P>0.05);NSE+NPT+S100β联合诊断病毒性脑炎、不典型化脓性脑炎的AUC(0.871、0.715)均大于NSE、NPT、S100β单项指标(0.652、0.609、0.418,0.633、0.365、0.574),诊断病毒性脑炎的AUC大于不典型化脓性脑炎。结论脑脊液中NSE、NPT水平在儿童病毒性脑炎中增高较不典型化脓性脑炎明显,NSE+NPT+S100β联合检测的诊断效率高于NSE、NPT、S100β单项指标检测。Objective To investigate value of neuron specific enolase （NSE） and neopterin （NPT） and central nerve specific protein 100β （S100β） in cerebrospinal fluid to the differentiation of viral encephalitis and atypical purulent encephalitis in children. Method Fifty-six children with central nervous system infection were divided into 32 children with viral encephalitis （viral encephalitis group） and 24 children with atypical purulent encephalitis （purulent encephalitis group）, and another 26 children without nerve system injury confirmed by lumbar puncture were as controls （control group）. The levels of NSE and S100β were detected by electrochemical luminescence and NPT level was detected by ELISA, and were compared among groups. ROC was drawn to evaluate the diagnostic value of single and joint detection of three markers for the differentiation of viral encephalitis and atypical purulent encephalitis. Results NPT level was significantly higher in viral encephalitis group （（70. 86± 15. 42） nmol/L） than that in purulent encephalitis group （（28.24±7. Z3） nmol/L） and control group （（25. 64±6. 18） nmol/L） （P〈0.05）, and there was no significant difference between purulent encephalitis group and control group （P〉0.05）. The levels of S100β （（1. 025±0. 38）, （0. 936±0.29） μg/L） and NSE （（29. 64 ± 6. 38）, （18. 55 ± 5. 72） μg/L） in viral encephalitis group and purulent encephalitis group were significantly higher than those in control group （（0. 37 ± 0. 11）, （9. 87±3.46） μg/L） （P〈 0.05）, NSE level was significantly higher in viral encephalitis group than that in purulent encephalitis group （P〈0.05）, and there was no significant difference in S100β level between viral encephalitis group and purulent encephalitis group （P〉0.05）. ROC showed that the AUC of joint detection of NSE, NPT and S100β for viral encephalitis and atypical purulent encephalitis （0. 871, 0. 715） were higher than those of the si

关 键 词：病毒性脑炎 不典型化脓性脑炎 神经特异性烯醇化酶 新喋呤 中枢神经特异蛋白 

分 类 号：R725.1[医药卫生—儿科] R742.9[医药卫生—临床医学]