摘要
目的探究蛛网膜下腔出血(subarachnoid hemorrhage,SAH)术后脑膜炎患者脑脊液趋化因子CXC配体13(chemokine CXC ligand 13,CXCL13),γ-干扰素诱导蛋白10(IFN-γinducible protein 10,IP-10)水平及其临床意义。方法选取2015年12月~2019年12月沈阳市第四人民医院诊治的134例SAH患者进行研究,依据患者是否并发脑膜炎分为未并发脑膜炎组(n=67)和并发脑膜炎组(n=67)。比较两组一般资料;以酶联免疫吸附法(ELISA)检测所有受试者脑脊液CXCL13和IP-10水平;以Pearson法分析SAH术后并发脑膜炎患者脑脊液CXCL13水平与IP-10的相关性;采用受试者特征工作曲线(ROC)评价脑脊液CXCL13和IP-10水平对SAH术后并发脑膜炎的诊断价值;Logistic回归分析SAH患者术后并发脑膜炎的影响因素。结果并发脑膜炎组脑脊液白细胞计数[575.96(72.84,994.64)×10^(6)/L vs 66.23(15.03,142.78)×10^(6)/L]、蛋白含量(1.98±0.59g/L vs 1.32±0.42 g/L)、乳酸含量(6.26±1.75mmol/L vs 3.48±1.06mmol/L)、CXCL13(485.73±171.90pg/ml vs 224.92±84.05pg/ml),IP-10(587.49±182.45ng/L vs 275.08±95.33 ng/L)水平均显著高于未并发脑膜炎组,差异均有统计学意义(Z/t=32.379,7.459,11.122,11.157和12.422,均P<0.001);SAH术后并发脑膜炎患者脑脊液CXCL13水平与IP-10呈正相关(r=0.471,P<0.05);脑脊液CXCL13和IP-10水平诊断SAH术后并发脑膜炎的曲线下面积(AUC)分别为0.855和0.862,对应截断值分别为327.84 pg/ml,451.43 ng/L,此时对应灵敏度分别为80.6%和74.6%,特异度分别为83.6%和89.6%;两者联合诊断SAH术后并发脑膜炎的AUC为0.914,相应灵敏度、特异度分别为89.6%和88.1%;白细胞计数、CXCL13,IP-10是影响SAH患者术后并发脑膜炎的危险因素(95%CI=1.199~2.752,1.166~2.763和1.251~2.999,均P<0.05)。结论CXCL13,IP-10在SAH术后并发脑膜炎患者脑脊液中水平显著上升,两者可能相互影响,进而共同影响术后并发脑膜炎进程,两者联合有助于筛查术后并发脑膜炎患者。
Objective To investigate the levels of chemokine CXC ligand 13(CXCL13)and IFN-γinducible protein 10(IP-10)in cerebrospinal fluid of patients with meningitis after subarachnoid hemorrhage(SAH)and their clinical significance.Methods A total of 134 SAH patients who were diagnosed and treated in the Fourth People’s Hospital of Shenyang City,from December 2015 to December 2019 were selected for study.According to whether the patients were complicated with meningitis,they were divided into non complicated meningitis group(n=67)and complicated meningitis group(n=67).The general data of the two groups were compared.The levels of CXCL13 and IP-10 in cerebrospinal fluid were detected by enzyme-linked immunosorbent assay(ELISA).The correlation between CXCL13 and IP-10 in cerebrospinal fluid of patients with meningitis after SAH was analyzed by Pearson method.The diagnostic values of CXCL13 and IP-10 in cerebrospinal fluid for meningitis after SAH were evaluated by ROC.In addition,Logistic regression was used to analyze the influencing factors of postoperative meningitis in SAH patients.Results Cerebrospinal fluid white blood cell count[575.96(72.84,994.64)×10^(6)/L vs 66.23(15.03,142.78)×10^(6)/L],protein content(1.98±0.59g/L vs 1.32±0.42 g/L),lactic acid content(6.26±1.75mmol/L vs 3.48±1.06 mmol/L),CXCL13(485.73±171.90 pg/ml vs 224.92±84.05 pg/ml),IP-10(587.49±182.45 ng/L vs 275.08±95.33 ng/L)level in the meningitis group was significantly higher than that of the group without meningitis,and the difference was statistically significant(Z/t=32.379,7.459,11.122,11.157和12.422,all P<0.001),and there was a positive correlation between the level of CXCL13 in cerebrospinal fluid and IP-10 in patients with meningitis after SAH(r=0.471,P<0.05).The area under curve(AUC)of the levels of CXCL13 and IP-10 in cerebrospinal fluid in the diagnosis of meningitis after SAH was 0.855 and 0.862,respectively and the corresponding cutoff value was 327.84 pg/ml and 451.43 ng/l,respectively.At this time,the corresponding sensitivity was 80.6% and 74.6%,and the specificity was 83.6%and 89.6%,respectively.The AUC of the combination was 0.914,and the sensitivity and specificity were 89.6%and 88.1%,respectively.In addition,white blood cell count,CXCL13 and IP-10 were the risk factors of postoperative meningitis in SAH patients(95%CI=1.199~2.752,1.166~2.763 and 1.251~2.999,all P<0.05).Conclusion The levels of CXCL13 and IP-10 in cerebrospinal fluid of patients with meningitis after SAH are significantly increased,which may influence each other,and then affect the process of meningitis after SAH.Therefore,the combination of the two is helpful to screen patients with meningitis after SAH.
作者
赵东肖
宋良月
ZHAO Dong-xiao;SONG liang-yue(Geriatric Center,the Fourth People’s Hospital of Shenyang City,Shenyang 110000,China)
出处
《现代检验医学杂志》
CAS
2021年第6期101-105,共5页
Journal of Modern Laboratory Medicine
基金
沈阳市科技计划项目(19-112-4-047)。
