炎性因子水平在中枢神经系统感染早期鉴别诊断中的研究  

Study on the early differential diagnosis of inflammatory factor levels in central nervous system infection

作　　者：张晓彤 宋文炜 赵亚琦 韩卫 ZHANG Xiao-tong;SONG Wen-wei;ZHAO Ya-qi(Clinical Laboratory,The Second Affiliated Hospital of Xuzhou Medical University/Clinical Laboratory/Xuzhou Mining Group General Hospital,Jiangsu Xuzhou 221006)

机构地区：[1]徐州医科大学第二附属医院/徐州矿务集团总医院检验科,江苏徐州1221006

出　　处：《医学检验与临床》2024年第8期20-24,共5页Medical Laboratory Science and Clinics

摘　　要：目的:探讨肝素结合蛋白(HBP)、降钙素原(PCT)、淀粉样蛋白A(SAA)、C反应蛋白(CRP)等炎性因子在中枢神经系统感染早期鉴别诊断中的应用价值。方法:采取回顾性研究模型,选取2020年1月-2022年3月间徐州医科大学第二附属医院收治住院的中枢神经系统感染性疾病患者100例为研究对象,根据感染类型,分为细菌性脑膜炎(BM)组55例,病毒性脑膜炎(VM)组45例。选择同期入院的非中枢神经系统感染患者40例为对照组。所有入组人员均检测血浆HBP、血清SAA、PCT和CRP等炎性指标水平,绘制受试者工作特征曲线(ROC),并比较各指标诊断和鉴别诊断中枢神经系统感染的效能。结果:BM组血浆HBP和血清SAA、PCT、CRP水平高于对照组和VM组,差异均有统计学意义(P<0.05)。HBP诊断BM的AUC在单一指标中最大为0.912(95%CI:0.848~0.975)。SAA诊断VM的AUC在单一指标中最大为0.907(95%CI:0.836~0.978),各指标联合检测鉴别BM和VM的AUC大于单一指标为0.978(95%CI:0.956~1.000),敏感度最高为89.1%,特异度最高为100%。结论:HBP、SAA、PCT、CRP等炎性指标均可作为鉴别诊断中枢神经系统感染性疾病性质的有效临床指标,HBP是细菌性脑膜炎较好的诊断指标,SAA是病毒性脑膜炎较好的诊断指标,可用于中枢神经系统感染早期诊断及感染程度评估,为中枢神经系统感染早期明确诊断提供参考。相关炎性因子联合诊断具有较高的敏感度及特异度,可提高鉴别化脓性脑膜炎和病毒性脑膜炎的诊断效能。Objective:To investigate the application value of inflammatory factors such as heparin-binding protein(HBP),procalcitonin(PCT),amyloid A(SAA),and C-reactive protein(CRP)in the early differential diagnosis of central nervous system infection.Methods:A retrospective study model was adopted.100 patients with infectious diseases of the central nervous system admitted to the Second Afiliated Hospital of Xuzhou Medical University from January 2020 to March 2022 were selected as the study subjects.According to the type of infection,they were divided into 55 cases of bacterial meningitis(BM)group,45 cases of viral meningitis(VM)group,and 40 cases of non-central nervous system infections admitted at the same time as the control group.All participants were tested for plasma HBP,serum SAA,PCT,and CRP levels,and receiver operating characteristic(ROC)curves were plotted to compare the eficacy of each indicator in diagnosing and differentiating central nervous system infections.Results:The levels of plasma HBP and serum SAA,PCT,and CRP in the BM group were higher than those in the control group and VM group,and the differences were statistically significant(P<0.05).The AUC of HBP for diagnosing BM is the highest among single indicators,with a value of 0.912(95%CI:0.848-0.975).The AUC of SAA in diagnosing VM is the highest among single indicators,with a value of 0.907(95%CI:0.836~0.978).The AUC of combined detection of various indicators for distinguishing BM and VM is greater than that of single indicators,with a value of 0.978(95%CI:0.956~1.000).The sensitivity is the highest at 89.1%,and the specificity is the highest at 100%.Conclusion:Inflammatory indicators such as HBP,SAA,PCT,and CRP can all be used as effective clinical indicators for the differential diagnosis of the nature of infectious diseases in the central nervous system.HBP is a better diagnostic indicator for bacterial meningitis,and SAA is a better diagnostic indicator for viral meningitis,which can be used for the early diagnosis of central nervous system infe

关 键 词：肝素结合蛋白 血清淀粉样蛋白A 降钙素原 C反应蛋白 中枢神经系统感染 

分 类 号：R446[医药卫生—诊断学]