摘要
目的 探讨小儿结核性脑膜炎(Tuberculous meningitis, TBM)外周血补体因子H(Complement factor H,CFH)、载脂蛋白A1(Apolipoprotein AI,ApoAI)和淀粉样蛋白A(Serum amyloid A,SAA)表达水平变化,分析其与TBM病情和预后的关系。方法 选择2017年3月-2021年1月本院收治的112例TBM患儿,根据英国医学研究理事会(Medical research council, MRC)分期标准分为Ⅰ期组(37例)、Ⅱ期组(46例)、Ⅲ期组(29例),根据改良Rankin量表(Modified Rankin Scale, mRS)评分将患儿分为预后良好组(0~2分,62例),预后不良组(≥3分,50例)。另选择71例健康儿童为对照组;检测血清CFH,ApoAI,SAA水平,分析其与TBM病情以及预后的关系。结果 TBM组血清CFH,SAA水平均高于对照组(P<0.05),ApoAI水平低于对照组(P<0.05);重度组血清CFH,SAA水平高于中度组和轻度组(P<0.05),ApoAI水平低于中度组和轻度组(P<0.05)。MRC分期Ⅲ期、高水平CFH、高水平SAA是TBM患者预后不良的危险因素(P<0.05),高水平ApoAI是TBM患者预后不良的保护因素(P<0.05)。CFH,ApoAI,SAA水平预测TBM患者预后不良的曲线下面积为0.613、0.610、0.592,联合CFH,ApoAI,SAA水平曲线下面积为0.855,高于单独CFH,ApoAI,SAA(z=6.275、5.936、6.569,P<0.05)。结论 TBM患儿血清CFH,SAA水平升高,ApoAI水平降低,且与TBM患儿病情加重以及不良预后有关。
Objective To investigate the expression of complement factor H(CFH), apolipoprotein A1(Apo AI), and amyloid A(SAA) in peripheral blood of children with tuberculous meningitis(TBM), and to analyze their relationship with the prognosis of TBM. Methods 112 children with TBM admitted to our hospital from March 2017 to January 2021 were divided into stage Ⅰ group(37 cases), Stage Ⅱ group(46 cases), and Stage Ⅲ group(29 cases) according to the British Medical Research Council(MRC) staging criteria. According to the modified Rankin scale(mRS) score, the children were divided into the good prognosis group(0-2 points, 62 cases), and the poor prognosis group(≥3 points, 50 cases).Another 71 healthy children were selected as the control group. Serum CFH, Apo AI and SAA levels were detected, and their relationship with disease severity and prognosis was analyzed.Results The serum CFH and SAA levels in the TBM group were higher than those in the control group(P < 0.05), while the serum Apo AI levels in the TBM group were lower than those in the control group(P< 0.05). The serum CFH and SAA levels in the severe group were higher than those in the moderate and mild groups(P < 0.05). The serum Apo AI levels were lower than those in moderate and mild groups(P< 0.05).MRC stage Ⅲ, high level of CFH, and SAA were risk factors for poor prognosis in TBM patients(P< 0.05). High level of Apo AI was a protective factor for poor prognosis in TBM patients(P< 0.05).CFH, Apo AI, SAA predicted poor prognosis of TBM patients with under the curve area of 0.613, 0.610, and 0.592, respectively. The area under the curve of combined CFH, Apo AI, and SAA is 0.855, higher than that of CFH, Apo AI, SAA alone(z =6.275, 5.936, 6.569, P< 0.05).Conclusion The serum CFH and SAA levels are increased, while the Apo AI levels are decreased in children with TBM, which was related to the aggravation of the disease and poor prognosis.
作者
刘建
王淑霞
张晓童
陈鹏
Liu Jian;Wang Shuxia;Zhang Xiaotong(Department of Pediatrics,Af filiated Hospital of Inmer Mongolia Chifeng University,Chifeng 024000;不详)
出处
《卒中与神经疾病》
2022年第5期422-426,共5页
Stroke and Nervous Diseases
基金
内蒙古自治区自然科学基金项目(2018MS113050)。
