测定PCT、CRP在鉴别中枢神经系统细菌感染和病毒感染的价值

发布时间：2018-05-28 08:45

本文选题：降钙素原 + C-反应蛋白　；参考：《山东大学》2012年硕士论文

【摘要】：目的考察血浆和脑脊液的降钙素原、C-反应蛋白水平在鉴别中枢神经系统细菌感染和病毒感染的价值。方法自2009年11月至2011年10月,收集本院小儿内科的中枢神经感染的患儿50例,其中27例为病毒性脑炎,男15例,女12例,年龄8.4±4.2月,23例为化脓性脑膜炎,男13例,女10例,年龄7.9±4.8月,另外收集25例同期住院的有神经系统症状但非感染的患儿作对照,男15例,女10例,年龄7.7±2.5月。采用酶联免疫吸附法(Enzyme Linked Immunosorbent Assay, ELISA)和免疫比浊(Immune Turbidimetry)检测法分别检测所有患儿治疗前后血浆和脑脊液中降钙素原、C-反应蛋白,并对各组治疗前后的指标进行比较。结果 3组患儿的性别、年龄和基础体温无明显差异,组间具有可比性。25例非感染患儿组在治疗前血浆的降钙素原25例均例低于0.5ng/mL。病毒性脑炎组治疗前血浆降钙素原水平分布：22例0.5ng/mL,3例在0.5ng/mL-2.0ng/mL之间,2例在2.0ng/mL-10.0ng/mL之间；化脓性脑膜炎组治疗前血浆降钙素原水平分布：2例0.5ng/mL,10例在0.5ng/mL-2.0ng/mL之间,7例在2.0ng/mL-10.0ng/mL之间,4例10.0ng/mL。与非感染组患儿比,病毒性脑炎组和化脓性脑膜炎组降钙素原0.5ng/mL的病例较少(P0.05),与病毒性脑炎组比,化脓性脑膜炎组血浆降钙素原水平显著增高(P0.05)。25例非感染组患儿在治疗前脑脊液的降钙素原均低于0.5ng/mL；病毒性脑炎组治疗前脑脊液降钙素原水平分布：24例0.5ng/mL,2例在0.5ng/mL-2.0ng/mL之间,1例在2.0ng/mL-10.0ng/mL之间；化脓性脑膜炎组治疗前脑脊液降钙素原水平分布：16例0.5ng/mL,5例在0.5ng/mL-2.0ng/mL之间,2例在2.0ng/mL-10.0ng/mL之间。与非感染组患儿组比,病毒性脑炎组脑脊液的4个降钙素原水平分布病例相似,0.5-10.0ng/mL的病例略高。与病毒性脑炎组比,化脓性脑膜炎组脑脊液降钙素原0.5ng/mL的病例较低(P0.05),0.5-10.Ong/mL的降钙素原无显著差异(P0.05)。25例非感染组患儿在治疗后血浆的降钙素原均低于0.5ng/mL。病毒性脑炎组治疗后血浆钙素原水平分布：23例0.5ng/mL,3例在0.5ng/mL-2.0ng/mL之间,1例在2.0ng/mL-10.0ng/mL之间；化脓性脑膜炎组治疗后血浆降钙素原水平分布：20例0.5ng/mL,2例在0.5ng/mL-2.Ong/mL之间,1例在2.0ng/mL-10.0ng/mL之间。与非感染组患儿组比,3个组别治疗后血浆降钙素原无显著差异(P0.05)。10例非感染组患儿在治疗后脑脊液的降钙素原均低于0.5ng/mL。病毒性脑炎组治疗后脑脊液降钙素原水平分布：25例0.5ng/mL,2例在0.5ng/mL-2.0ng/mL之间；化脓性脑膜炎组治疗后脑脊液降钙素原水平分布：22例0.5ng/mL,1例在0.5ng/mL-2.0ng/mL之间。3个组别治疗后脑脊液降钙素原无显著差异(P0.05)。25例非感染组患儿血浆C-反应蛋白低于2.2mg/L。与非感染组患儿组比,病毒性脑炎组血浆C-反应蛋白水平无显著差异(2.08±0.12mg/L vs.2.15±0.66mg/L,P0.05),化脓性脑膜炎组血浆C-反应蛋白水平显著增高(2.08±0.12mg/L vs.76.28±24.77mg/L,P0.05)；与病毒性脑炎组比,化脓性脑膜炎血浆C-反应蛋白水平明显增高(2.15±0.66mg/L vs.76.28±24.77mg/L,P0.05)。非感染组患儿脑脊液C-反应蛋白水平低于1.3mg/L。与非感染组患儿组比,病毒性脑炎组脑脊液C-反应蛋白水平无显著差异(1.01±0.13mg/L vs.1.32±1.18mg/L,P0.05),化脓性脑膜炎组脑脊液C-反应蛋白水平显著增高(1.01±0.13mg/L vs.9.48±2.68mg/L,P0.05)；与病毒性脑炎组比,化脓性脑膜炎组脑脊液C-反应蛋白水平明显增高(1.32±1.18mg/L vs.9.48±2.68mg/L,P0.05)。治疗后,非感染组患儿血浆C-反应蛋白低于2.2mg/L。与非感染组患儿比,病毒性脑炎组的血浆C-反应蛋白水平无显著变化(2.06±0.21mg/L vs.2.10±0.15mg/L,P0.05),化脓性脑膜炎组血浆C-反应蛋白水平仍然较高(2.06±0.21mg/L vs.10.64±2.21mg/L,P0.05)；与病毒性脑炎组比,化脓性脑膜炎组血浆C-反应蛋白水平较高(2.06±0.21mg/L vs.10.64±2.21mg/L,P0.05)治疗后,非感染组患儿脑脊液C-反应蛋白水平低于1.3mg/L。与非感染组患儿比,病毒性脑炎组的脑脊液C-反应蛋白水平无显著变化(1.10±0.08mg/L vs.1.21±0.20mg/LP0.05),化脓性脑膜炎组脑脊液C-反应蛋白水平仍然较高(1.10±0.08mg/L vs.4.26±1.21mg/L,P0.05)；与病毒性脑炎组比,化脓性脑膜炎组脑脊液C-反应蛋白水平较高(1.21±0.20mg/L vs.4.26±1.21mg/L,P0.05)与治疗前比,非感染组患儿治疗后血浆C-反应蛋白水平没有显著变化(2.08±0.12mg/L vs.2.06±0.21mg/L,P0.05)与治疗前比,病毒性脑炎组患儿治疗后血浆C-反应蛋白水平没有显著变化(2.15±0.66mg/L vs.2.10±0.15mg/L,P0.05)与治疗前比,化脓性脑膜炎组患儿治疗后血浆C-反应蛋白水平显著降低(76.28±24.77mg/L vs.10.64±2.21mg/L,P0.05)与治疗前比,非感染组患儿治疗后脑脊液C-反应蛋白水平没有显著变化(1.01±0.13mg/L vs.1.10±0.08mg/L,P0.05),与治疗前比,病毒性脑膜炎组患儿治疗后脑脊液C-反应蛋白水平没有显著变化(1.32±1.18mg/L vs.1.21±0.20mg/L,P0.05)与治疗前比,化脓性脑膜炎组患儿治疗后脑脊液C-反应蛋白水平显著降低(9.48±2.68mg/L vs.4.26±1.21mg/L,P0.05)。结论联合检测患者血浆降钙素原和C-反应蛋白,可提高鉴别病毒和细菌感染的中枢神经系统疾病的能力,及时指导临床用药、换药、减量和停药,并减少抗生素滥用几率
[Abstract]:objective
Objective to investigate the value of procalcitonin and C- reactive protein in differential diagnosis of central nervous system bacterial infection and viral infection.
Method
From November 2009 to October 2011, 50 children with central nervous infection in the Department of Pediatrics in our hospital were collected, of which 27 were viral encephalitis, 15 men, 12 women, 8.4 + 4.2 months, 23 cases of suppurative meningitis, 13 males, 10 cases, 7.9 + 4.8 months, and also collected 25 cases of nervous system symptoms but non infected children in the same period of hospitalization. Control, 15 men and 10 women, age 7.7 + 2.5 months. Enzyme Linked Immunosorbent Assay (ELISA) and immunoturbidimetry (Immune Turbidimetry) were used to detect calcitonin and C- reactive protein in the plasma and cerebrospinal fluid (CSF) before and after treatment, and the indexes were compared before and after treatment.
Result
There was no significant difference in sex, age and basal body temperature in the 3 groups. Among the groups, 25 cases of plasma calcitonin before treatment in.25 cases were lower than those of 0.5ng/mL. viral encephalitis before treatment, 22 cases of 0.5ng/mL, 3 cases between 0.5ng/ mL-2.0ng/mL and 2 in 2.0ng/mL-10.0ng/mL. Plasma calcitonin levels were distributed before treatment in the purulent meningitis group: 2 cases of 0.5ng/mL, 10 cases between 0.5ng/mL-2.0ng/mL, 7 cases in 2.0ng/mL-10.0ng/mL, 4 cases of 10.0ng/mL. and non infected children, fewer cases of calcitonin 0.5ng/mL in viral encephalitis and suppurative meningitis group (P0.05), compared with viral encephalitis group, suppurative The levels of calcitonin in the plasma of the meningitis group increased significantly (P0.05) the calcitonin in the cerebrospinal fluid before treatment was lower than that of 0.5ng/mL in.25 non infected children. The distribution of calcitonin in cerebrospinal fluid before treatment in viral encephalitis group: 24 cases of 0.5ng/mL, 2 cases in 0.5ng/mL-2.0ng/mL, 1 cases between 2.0ng/mL-10.0ng/mL; suppurative meningitis. The level distribution of calcitonin in cerebrospinal fluid before treatment: 16 cases of 0.5ng/mL, 5 cases between 0.5ng/mL-2.0ng/mL and 2 cases between 2.0ng/mL-10.0ng/mL. Compared with the non infected group, the 4 cases of calcitonin in the cerebrospinal fluid of viral encephalitis group were similar, and the cases of 0.5-10.0ng/mL were slightly higher. The ratio of the pyogenic meningitis group with the viral encephalitis group, the pyogenic meningitis group was compared with the patients with viral encephalitis. The cases of calcitonin 0.5ng/mL in cerebrospinal fluid (P0.05) were lower (P0.05), and there was no significant difference in calcitonin in 0.5-10.Ong/mL (P0.05) the plasma calcitonin levels were lower in.25 non infected children than in 0.5ng/mL. viral encephalitis group after treatment: 23 cases of 0.5ng/ mL, 3 cases in 0.5ng/mL-2.0ng/mL, and 1 cases in 2.0ng/mL-10.0. Ng/mL; plasma calcitonin levels after treatment with pyogenic meningitis group: 20 cases of 0.5ng/mL, 2 cases in 0.5ng/mL-2.Ong/mL, 1 cases between 2.0ng/mL-10.0ng/mL. Compared with the non infected group, there was no significant difference in plasma calcitonin in 3 groups after treatment (P0.05).10 cases of non infected children after treatment of cerebrospinal fluid calcitonin The distribution of calcitonin levels in cerebrospinal fluid after treatment with 0.5ng/mL. viral encephalitis group: 25 cases of 0.5ng/mL and 2 cases between 0.5ng/mL-2.0ng/mL; the distribution of calcitonin in cerebrospinal fluid after treatment with pyogenic meningitis group: 22 cases of 0.5ng/mL and 1 cases of 0.5ng/mL-2.0ng/mL between.3 groups after treatment (P 0.05) the plasma C- reactive protein in the non infected.25 group was lower than that of the non infected group. The plasma C- reactive protein level of the viral encephalitis group was not significantly different (2.08 + 0.12mg/L vs.2.15 + 0.66mg/L, P0.05), and the level of the plasma C- reactive protein in the suppurative meningitis group was significantly increased (2.08 + 0.12mg/L vs.76.28 24.77mg/L,); The level of C- reactive protein in the plasma of viral encephalitis was significantly higher (2.15 + 0.66mg/L vs.76.28 + 24.77mg/L, P0.05). The level of C- reactive protein in the cerebrospinal fluid of the non infected children was lower than that of the non infected group, and there was no significant difference in the level of C- reactive protein (1.01 + 0.13mg/L vs.1.32 + 1.) in the cerebrospinal fluid of the viral encephalitis group (1.01 + 0.13mg/L vs.1.32 + 1.). 18mg/L, P0.05), the level of C- reactive protein in cerebrospinal fluid of the suppurative meningitis group increased significantly (1.01 + 0.13mg/L vs.9.48 + 2.68mg/L, P0.05), and the level of C- reactive protein in the cerebrospinal fluid of the purulent meningitis group was significantly higher than that in the viral encephalitis group (1.32 + 1.18mg/L vs.9.48 + 2.68mg/L, P0.05). The plasma C- reactive protein level of viral encephalitis group was not significantly changed between 2.2mg/L. and non infected children (2.06 + 0.21mg/L vs.2.10 + 0.15mg/L, P0.05). The plasma C- reactive protein level in the suppurative meningitis group was still higher (2.06 + 0.21mg/L vs.10.64 + 2.21mg/L, P0.05), compared with the viral encephalitis group, the suppurative meningitis group had plasma C- reaction. After the high protein level (2.06 0.21mg/L vs.10.64 + 2.21mg/L, P0.05), the level of C- reactive protein in the cerebrospinal fluid of the non infected children was lower than that of the non infected group. There was no significant change in the level of C- reactive protein (1.10 + 0.08mg/L vs.1.21 + 0.20mg/LP0.05) in the cerebrospinal fluid of the viral encephalitis group (1.10 0.08mg/L vs.1.21 + 0.20mg/LP0.05), and the cerebrospinal fluid in the purulent meningitis group was C-. The protein level was still higher (1.10 + 0.08mg/L vs.4.26 + 1.21mg/L, P0.05). Compared with the viral encephalitis group, the level of C- reactive protein in the cerebrospinal fluid of the purulent meningitis group was higher (1.21 + 0.20mg/L vs.4.26 + 1.21mg/L, P0.05) than before the treatment. There was no significant change in the plasma C- reactive protein level (2.08 + 0.12mg/L vs.2.) in the non infected children after treatment. 06 + 0.21mg/L, P0.05) and before treatment, the level of C- reactive protein in the patients with viral encephalitis was not significantly changed (2.15 + 0.66mg/L vs.2.10 + 0.15mg/L, P0.05), and the level of C- reactive protein in the purulent meningitis group decreased significantly (76.28 + 24.77mg/L vs.10.64 + 2.21mg/L, P0.05) before treatment. There was no significant change in the C- reactive protein level in the cerebrospinal fluid (1.01 + 0.13mg/L vs.1.10 + 0.08mg/L, P0.05) after treatment in the non infected group, and there was no significant change in the level of C- reactive protein in the cerebrospinal fluid of the viral meningitis group (1.32 + 1.18mg/L vs.1.21 + 0.20mg/L, P0.05) and the pyogenic meningitis group. After treatment, the level of C- reactive protein in CSF decreased significantly (9.48 + 2.68mg/L vs.4.26 + 1.21mg/L, P0.05).
conclusion
Combined detection of calcitonin and C- reactive protein in patients can improve the ability to identify viruses and bacterial infections in the central nervous system, timely guide clinical medication, change drugs, reduce and stop drugs, and reduce the risk of antibiotic abuse.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

【参考文献】