脑脊液降钙素、超敏C反应蛋白、神经元特异性烯醇化酶水平在脑膜炎预后预测及感染类型鉴别中的作用

Clinical significance of cerebrospinal fluid and serum procalcitonin, high-sensitivity C-reactive protein, and neuron-specific enolase levels in meningitis prognosis prediction and infection type identification

摘要:

目的 探讨脑脊液降钙素(PCT)、超敏C反应蛋白(hs-CRP)、神经元特异性烯醇化酶(NSE)水平在脑膜炎感染类型鉴别和临床预后预测中的价值。方法 选取2016年1月至2019年年12月期间在该院确诊并治疗的123例脑膜炎为研究病例。所有病例入院确诊为脑膜炎后即进行气道通畅、监测深静脉的静脉压、血氧饱和度检测、液体循环复苏等常规治疗。完善脑脊液生化检查确定后，化脓性感染病例给予抗菌药物治疗；病毒性感染病例给予抗病毒治疗。于治疗前对脑脊液PCT、hs-CRP、NSE水平进行检测，观察病毒性病例与化脓性病例、预后良好病例与预后不佳病例之间脑脊液PCT、hs-CRP、NSE的表达差异，并分析脑脊液PCT、hs-CRP、NSE联合应用在病毒性脑膜炎与化脓性脑膜炎鉴别及其在临床预后预测中的价值。结果 病毒性脑膜炎病例的脑脊液PCT、hs-CRP、NSE水平低于化脓性脑膜炎病例，差异有统计学意义(P<0.05)。脑脊液PCT、hs-CRP、NSE联合应用鉴别病毒性与化脓性脑膜炎的敏感性(84.18%)、特异性(86.19%)、准确性(83.04%)高于单纯脑脊液PCT、单纯脑脊液hs-CRP、单纯脑脊液NSE。预后良好病例的脑脊液PCT、hs-CRP、NSE水平低于预后不佳患儿，差异有统计学意义(P<0.05)。脑脊液PCT、hs-CRP、NSE联合预测临床预后的敏感性(83.93%)、特异性(85.83%)、准确性(84.20%)高于单纯脑脊液PCT、单纯脑脊液hs-CRP、单纯脑脊液NSE。结论 脑脊液PCT、hs-CRP、NSE联合应用在病毒性脑膜炎与化脓性脑膜炎鉴别和临床预后预测中均具有较高的临床价值，有望作为脑膜炎临床诊疗的指导性指标。

Abstract:

Objective To investigate the clinical significance of cerebrospinal fluid （CSF） and serum procalcitonin （PCT）， high-sensitivity C-reactive protein （hs-CRP）， and neuron-specific enolase （NSE） levels in meningitis infection type identification and clinical prognosis prediction.Methods A total of 123 cases of meningitis diagnosed and treated in the Bozhou People’s Hospital from January 2016 to December 2019 were enrolled in this study. All cases were treated with routine treatments such as airway patency， venous pressure monitoring via the deep vein， blood oxygen saturation measurement， fluid resuscitation， and other conventional treatments as soon as they were diagnosed as meningitis. Once the diagnosis was confirmed by CSF biochemical examination， the purulent infection cases were given antibacterial treatment and the viral infection cases were given antiviral treatment. The CSF PCT， hs-CRP， and NSE levels were measured before treatment， and the differences in the expression of CSF PCT， hs-CRP， and NSE between viral cases and purulent cases and between cases with good prognosis and cases with poor prognosis were investigated. The clinical significance of the combined measurement of PCT， hs-CRP， and NSE in differentiation between viral meningitis and purulent meningitis and their clinical prognosis prediction were analyzed.Results The viral meningitis cases had significantly lower CSF PCT， hs-CRP， and NSE levels compared with the purulent meningitis cases （P<0.05）. The combined measurement of CSF PCT， hs-CRP， and NSE had higher sensitivity （84.18%）， specificity （86.19%）， and accuracy （83.04%） in differentiating viral and purulent meningitis compared with measuring CSF PCT， hs-CRP， or NSE alone. Cases with good prognosis had significantly lower CSF PCT， hs-CRP， and NSE compared with those with poor prognosis （P<0.05）. The combined measurement of CSF PCT， hs-CRP， and NSE had higher sensitivity （83.93%）， specificity （85.83%）， and accuracy （84.20%） in predicting clinical prognosis compared with measuring CSF PCT， hs-CRP， or NSE alone.Conclusions The combined measurement of CSF PCT， hs-CRP， and NSE levels has high clinical value in differentiation between viral meningitis and purulent meningitis and clinical prognosis prediction， and shows promise for being a guiding indicator for the clinical diagnosis and treatment of meningitis.