脑脊液和血浆中性粒细胞外诱捕网标志物对结核性脑膜炎与化脓性脑膜炎的鉴别诊断价值  

Value of neutrophil extracellular traps markers in cerebrospinal fluid and plasma in differential diagnosis of tuberculous meningitis and purulent meningitis

作　　者：古力加乃提·麦麦吐逊 麦路德木·麦麦吐逊[3] 王静静[2] 严伟[2] Gulijianaiti Maimaituxun;Mailudemu Maimaituxun;WANG Jingjing;YAN Wei(State Key Laboratory of Pathogenesis,Prevention,and Treatment of High Incidence Diseases in Central Asia,Urumqi 830000,China;不详)

机构地区：[1]省部共建中亚高发病成因与防治国家重点实验室,乌鲁木齐830000 [2]喀什地区第一人民医院神经内科 [3]喀什地区第一人民医院药学部

出　　处：《山东医药》2024年第29期25-28,共4页Shandong Medical Journal

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2021-JH)。

摘　　要：目的探讨脑脊液、血浆中性粒细胞外诱捕网(NETs)标志物对结核性脑膜炎与化脓性脑膜炎的鉴别诊断价值。方法选择结核性脑膜炎患者20例纳入结核性脑膜炎组、化脓性脑膜炎患者30例纳入化脓性脑膜炎组、因鉴别诊断需要进行腰椎穿刺术的脑脊液正常患者20例纳入正常对照组。采用ELISA法检测各组脑脊液及血浆NETs标志物[中性粒细胞弹性蛋白酶(NE)-DNA复合物、髓过氧化物酶(MPO)-DNA复合物]。绘制受试者工作特征(ROC)曲线,评价脑脊液、血浆NETs标志物对结核性脑膜炎与化脓性脑膜炎的鉴别诊断价值。结果正常对照组血浆NE-DNA复合物水平比较、结核性脑膜炎组、化脓性脑膜炎组脑脊液MPO-DNA复合物、NE-DNA复合物水平依次增高(P均<0.05)。化脓性脑膜炎组血浆NE-DNA复合物水平高于结核性脑膜炎组和正常对照组(P均<0.05),结核性脑膜炎组与正常对照组比较差异无统计学意义;三组血浆MPO-DNA复合物水平比较差异无统计学意义(P均>0.05)。脑脊液NE-DNA复合物、MPO-DNA复合物鉴别结核性脑膜炎与化脓性脑膜炎的ROC曲线下面积(AUC)分别为0.961、0.945,灵敏度分别为92.36%、89.44%,特异度分别88.35%、85.29%;血浆NE-DNA复合物、MPO-DNA复合物鉴别结核性脑膜炎与化脓性脑膜炎的AUC分别为0.720、0.709,灵敏度分别为84.62%、80.49%,特异度分别为80.18%、73.55%。结论与化脓性脑膜炎比较,结核性脑膜炎患者脑脊液MPO-DNA复合物、NE-DNA复合物水平及血浆NE-DNA复合物水平降低;脑脊液NETs标志物检测可能有助于结核性脑膜炎与化脓性脑膜炎的鉴别诊断。Objective To investigate the value of neutrophil extracellular traps(NETs)markers in the cerebrospinal fluid and plasma in differential diagnosis of tuberculous meningitis and purulent meningitis.Methods Twenty patients with tuberculous meningitis were selected in the tuberculous meningitis group,30 patients with purulent meningitis were included in the septic meningitis group,and 20 patients with normal cerebrospinal fluid who required lumbar puncture surgery for differential diagnosis were selected as the normal control group.ELISA was used to detect NETs markers[neutrophil elastase(NE)-DNA complex,myeloperoxidase(MPO)-DNA complex]in cerebrospinal fluid and plasma of each group.We drew receiver operating characteristic(ROC)curves to evaluate the value of cerebrospinal fluid and plasma NETs markers in differential diagnosis of tuberculous meningitis and purulent meningitis.Results The levels of MPO-DNA complexes and NE-DNA complexes in the cerebrospinal fluid of the normal control group,tuberculous meningitis group,and purulent meningitis group increased sequentially(all P<0.05).The level of plasma NE-DNA complex was higher in the purulent meningitis than in the tuberculous meningitis group and normal control group(both P<0.05),but there was no statistically significant difference between tuberculous meningitis group and normal control group;there was no statistically significant difference in the levels of MPO-DNA complexes in the plasma among these three groups.The area under the ROC curve(AUC)of cerebrospinal fluid NE-DNA complex and MPO-DNA complex in distinguishing tuberculous meningitis and purulent meningitis was 0.961 and 0.945,respectively,with sensitivities of 92.36%and 89.44%,and specificities of 88.35%and 85.29%,respectively.The AUC of plasma NE-DNA complex and MPO-DNA complex in distinguishing tuberculous meningitis and purulent meningitis was 0.720 and 0.709,respectively,with the sensitivities of 84.62%and 80.49%,and the specificities of 80.18%and 73.55%,respectively.Conclusions The levels of MPODN

关 键 词：结核性脑膜炎 化脓性脑膜炎 中性粒细胞外诱捕网 中性粒细胞弹性蛋白酶 髓过氧化物酶 脑脊液 

分 类 号：R741[医药卫生—神经病学与精神病学] R529.3[医药卫生—临床医学]