新生儿化脓性脑膜炎血清和脑脊液PCT与IL-6及hs-CRP与预后的关系  

Relationship between PCT,IL-6and hs-CRP in serum and cerebrospinal fluid and prognosis of neonates with purulent meningitis

作　　者：李晶[1] 李明霞[1] 巴依尔才次克[1] 赵婷[1] 王彦梅 LI Jing;LI Ming-xia;Bayiercaicike;ZHAO Ting;WANG Yan-mei(The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang830054,China)

机构地区：[1]新疆医科大学第一附属医院新生儿科,新疆乌鲁木齐830054

出　　处：《中华医院感染学杂志》2021年第18期2831-2836,共6页Chinese Journal of Nosocomiology

基　　金：乌鲁木齐市自然科学基金资助项目(2019Z26124)。

摘　　要：目的探究新生儿化脓性脑膜炎(PM)血清和脑脊液降钙素原(PCT)、白细胞介素-6(IL-6)和超敏C-反应蛋白(hs-CRP)与预后的关系。方法收集2017年8月-2020年8月新疆医科大学第一附属医院收治的102例脑膜炎新生儿的临床资料,根据脑膜炎类型,分为病毒性脑膜炎(VM,n=26)组、PM(n=76)组;根据预后情况,将PM组分为死亡患儿(n=15)、好转患儿(n=61),统计各组患儿抗菌药物治疗前、治疗后3d血清和脑脊液PCT、IL-6、hs-CRP水平,利用受试者工作曲线(ROC)分析脑脊液和血清PCT、IL-6、hs-CRP对PM预后评估的价值。结果治疗前,VM组血清、脑脊液PCT、IL-6、hs-CRP水平均低于PM组(P<0.05)。入院时脑脊液PCT、IL-6、hs-CRP三者联合诊断PM的曲线下面积(AUC)为0.966,高于血液PCT、IL-6、hs-CRP三者联合诊断的0.939。本研究中经临床确诊的76例PM新生儿经血液病原菌培养分离病原菌23株,培养阳性率为30.26%(23/76),病原菌中革兰阳性菌占52.17%(12/23)、革兰阴性菌占47.83%(11/23),以大肠埃希菌和金黄色葡萄球菌为主;金黄色葡萄球菌对环丙沙星、培氟沙星、亚胺培南的耐药率较低;大肠埃希菌对亚胺培南、培氟沙星、环丙沙星、左氧氟沙星、阿米卡星敏感。抗菌药物治疗3d后,死亡患儿血液、脑脊液PCT、IL-6、hs-CRP高于好转患儿(P<0.05);抗菌药物治疗3d后,脑脊液PCT、IL-6、hs-CRP三者联合诊断PM的AUC为0.861,高于血液PCT、IL-6、hs-CRP三者联合诊断的0.821。结论PM新生儿血清、脑脊液中可检测到PCT、IL-6、hs-CRP高表达,血清和脑脊液PCT、IL-6、hs-CRP水平联合检测均在PM预后评估中具有较高的应用价值。OBJECTIVE To explore the relationship between procalcitonin(PCT),interleukin 6(IL-6)and high sensitivity C-reactive protein(hs-CRP)in serum and cerebrospinal fluid(CSF)and prognosis of neonates with purulent meningitis(PM).METHODS The clinical data of 102PM neonates admitted to the first affiliated hospital of Xinjiang medical university from August 2017to August 2020were collected,and were divided into viral meningitis group(VM group,n=26)and PM group(n=76)according to the type of meningitis.According to the prognosis,patients in PM group were divided into death group(n=15)and improvement group(n=61).The levels of PCT,IL-6and hs-CRP in serum and CSF of each group before and 3dafter antibiotic treatment were statistically analyzed.The receiver operating characteristic(ROC)curve was used to analyze the value of PCT,CGRP and hs-CRP in serum and CSF in the prognostic evaluation of PM.RESULTS Before treatment,the levels of PCT,IL-6and hs-CRP in serum and CSF of VM group were significantly lower than those in PM group(P<0.05).The AUC of PCT,IL-6and hs-CRP in the CSF for the combined diagnosis of PM at admission was 0.966,significatly higher than 0.939in the combined diagnosis of blood PCT,IL-6and hs-CRP.In this study,23strains of pathogens were isolated from 76neonates clinically confirmed with PM by blood pathogens culture,and the positive rate of culture was 30.26%(23/76).Among the pathogens,Gram-positive bacteria and Gram-negative bacteria accounted for 52.17%(12/23)and 47.83%(11/23),respectively,mainly Escherichia coli and Staphylococcus aureus;Staphylococcus aureus had low resistance rates to ciprofloxacin,pefloxacin and imipenem.E.coli was sensitive to imipenem,pefloxacin,ciprofloxacin,levofloxacin and amikacin.After 3days of antibiotic treatment,the levels of PCT,IL-6and hs-CRP in serum and CSF of death group were significantly significatly higher than those in improvement group(P<0.05).After 3days of antimicrobial treatment,the AUC of the combined diagnosis of PM by cerebrospinal fluid PCT,IL-6and hs-CRP was 0

关 键 词：化脓性脑膜炎 败血症 降钙素原 新生儿 预后 

分 类 号：R722.1[医药卫生—儿科]