目的:中枢神经系统感染,以细菌性脑膜炎为代表,作为神经学家反复面临的关键紧急情况。及时准确的诊断是有效干预的基石。本研究致力于研究脑脊液中与中性粒细胞相关的炎性蛋白水平对中枢神经系统感染性疾病预后的影响。
方法:本回顾性病例系列研究在山东大学第二医院神经内科进行,涵盖2018年1月至2024年1月通过PCR检测和其他诊断方法确认的感染性脑炎患者.通过ELISA对患者脑脊液中MPO和相关炎性蛋白进行定量。
结果:我们招募了25名诊断为细菌性脑膜炎的患者,通过PCR检测确定,并将其分为两组:预后良好的组(n=25)和预后不良的组(n=25)。在对正态和方差进行评估之后,在细菌性脑膜炎患者的预后类别之间,CSF-MPO浓度存在显著差异(P<0.0001).此外,对有利和不利预后组的人口统计学数据的审查揭示了CSF-IL-1β的区别,CSF-IL-6,CSF-IL-8,CSF-IL-18,CSF-TNF-α水平,相关分析揭示了与MPO的稳健关联。ROC曲线分析描绘了当CSF-MPO≥16.57ng/mL时,细菌性脑膜炎的不良预后可能性为83%.同样,当CSF-IL-1β,CSF-IL-6、CSF-IL-8、CSF-IL-18和CSF-TNF-α水平达到3.83pg/mL,123.92pg/mL,4230.62pg/mL,35.55pg/mL,和35.19pg/mL,分别,细菌性脑膜炎预后不良的可能性为83%.
结论:检测脑脊液样本中的中性粒细胞胞外捕获物MPO和相关的炎性蛋白水平有望预测细菌性脑膜炎,因此,在患有这种疾病的患者的预后评估中具有至关重要的意义。
OBJECTIVE: Central nervous system infections, typified by bacterial meningitis, stand as pivotal emergencies recurrently confronted by neurologists. Timely and precise diagnosis constitutes the cornerstone for efficacious intervention. The present study endeavors to scrutinize the influence of inflammatory protein levels associated with neutrophils in cerebrospinal fluid on the prognosis of central nervous system infectious maladies.
METHODS: This retrospective case series study was undertaken at the Neurology Department of the Second Hospital of Shandong University, encompassing patients diagnosed with infectious encephalitis as confirmed by PCR testing and other diagnostic modalities spanning from January 2018 to January 2024. The quantification of MPO and pertinent inflammatory proteins within patients\' cerebrospinal fluid was accomplished through the utilization of ELISA.
RESULTS: We enlisted 25 patients diagnosed with bacterial meningitis, ascertained through PCR testing, and stratified them into two groups: those with favorable prognoses (n = 25) and those with unfavorable prognoses (n = 25). Following assessments for normality and variance, notable disparities in CSF-MPO concentrations emerged between the prognostic categories of bacterial meningitis patients (P < 0.0001). Additionally, scrutiny of demographic data in both favorable and unfavorable prognosis groups unveiled distinctions in CSF-IL-1β, CSF-IL-6, CSF-IL-8, CSF-IL-18, CSF-TNF-α levels, with correlation analyses revealing robust associations with MPO. ROC curve analyses delineated that when CSF-MPO ≥ 16.57 ng/mL, there exists an 83% likelihood of an adverse prognosis for bacterial meningitis. Similarly, when CSF-IL-1β, CSF-IL-6, CSF-IL-8, CSF-IL-18, and CSF-TNF-α levels attain 3.83pg/mL, 123.92pg/mL, 4230.62pg/mL, 35.55pg/mL, and 35.19pg/mL, respectively, there exists an 83% probability of an unfavorable prognosis for bacterial meningitis.
CONCLUSIONS: The detection of neutrophil extracellular traps MPO and associated inflammatory protein levels in cerebrospinal fluid samples holds promise in prognosticating bacterial meningitis, thereby assuming paramount significance in the prognostic evaluation of patients afflicted with this condition.