P物质、IL-17、IL-6在化脓性脑膜炎和病毒性脑炎中的表达变化

发布时间：2018-07-04 09:22

本文选题：化脓性脑膜炎 + 病毒性脑炎　；参考：《郑州大学》2017年硕士论文

【摘要】：研究背景与目的中枢神经系统感染(Infections of Central Nervous System,ICNS)性疾病是临床常见病、多发病。化脓性脑膜炎(purulent meningitis,PM,简称化脑)和病毒性脑炎(viral encephalitis,VE,简称病脑)均是常见的中枢神经系统感染性疾病,且常伴随有相对较高的死亡率和神经系统后遗症率。化脓性脑膜炎一直是危害儿童健康的中枢神经系统感染性疾病,虽然随着抗生素的应用,死亡率有所下降,但后遗症发生率仍居高不下,国外有研究报道,80年代化脓性脑膜炎急性期的病死率为22%,随着医疗技术的发展,至90年代下降至6.6%,而神经系统后遗症的发生率在十年间的改变极微小,仍分别高达25.5%和23.5%[1]。病毒性脑炎如单纯疱疹病毒性脑炎、肠道病毒性脑炎、虫媒性脑炎等发病急骤,进展快,危害大,大多数仍有后遗症。因此尽早确诊化脓性脑膜炎和病毒性脑炎,及时有效治疗是预后的关键。但目前由于抗生素的普遍应用,单从脑脊液的外观、常规、生化不易鉴别化脑和病脑。因此,近年研究中枢神经系统感染在脑内的免疫机制寻找鉴别化脓性脑膜炎和病毒性脑炎简单可行的方法成为研究热点。本研究通过检测急性期化脑和病脑患儿脑脊液中P物质(Substance P,SP)、白介素17(Interleukin-17,IL-17)、白介素6(Interleukin-6,IL-6)的浓度,比较这些指标在早期化脑和病脑中的表达水平,探讨其临床意义及相关的免疫学机制,为临床鉴别化脑和病脑提供理论依据。研究方法选取2014年12月-2016年4月在我院住院治疗明确诊断为化脑(诊断标准符合诸福棠实用儿科学第七版)的患儿23例,男15例,女8例,年龄1个月-4岁6个月(2.3±1.7)岁;同期明确诊断为病脑(诊断标准符合诸福棠实用儿科学第七版)的患儿25例,男16例,女9例,年龄3个月-8岁(3.7±2.4)岁;对照组30例,男19例,女11例,年龄3个月-6岁(2.6±1.8)岁,为同期住院的排除颅内感染的、无免疫缺陷的儿童。3组患儿的年龄、性别、体重等基本情况比较无统计学意义(P0.05),具有可比性。3组患儿均在入院后24h内进行腰椎穿刺,采集CSF 5ml,其中3ml送至检验室进行生化、常规、三染色检查,2ml于无菌EP管中,置于-80℃中保存待检。采用酶联免疫法(ELISA)检测CSF中SP、IL-17、IL-6的浓度。采用SPSS 21.0统计软件包进行处理,以α=0.05为检验标准。结果化脑组、病脑组和对照组CSF中SP水平分别为(1176.33±249.03)ug/L,(562.57±40.81)ug/L,(95.60±43.50)ug/L,IL-17水平分别为(463.54±152.05)ug/L,(59.46±26.12)ug/L,(8.87±5.96)ug/L,IL-6水平分别为(283.97±74.07)ug/L,(132.81±39.78)ug/L,(6.62±2.02)ug/L,三组间3项指标差异均有统计学意义(P0.05)。两两比较各组间均有统计学差异(P0.05)。化脑组CSF中SP、IL-17、IL-6水平均分别明显高于病脑组和对照组,病脑组CSF中SP、IL-17、IL-6水平均分别明显高于对照组。结论1.化脓性脑膜炎和病毒性脑炎急性期,脑脊液中P物质、IL-17、IL-6表达水平增高,且化脓性脑膜炎组增高明显。2.中枢神经系统感染急性期患儿脑脊液中P物质、IL-17、IL-6可能参与了疾病的发展过程,在一定程度上可作为鉴别化脑和病脑的参考指标。
[Abstract]:Background and objective Infections of Central Nervous System (ICNS) is a common clinical disease. It is a common disease. Suppurative meningitis (purulent meningitis, PM, brain) and viral encephalitis (viral encephalitis, VE, and brain) are common central nervous system infectious diseases, often accompanied by the disease. Relatively high mortality and the rate of sequelae of the nervous system. Suppurative meningitis has always been a central nervous system infectious disease that endangers children's health. Although with the application of antibiotics, the mortality rate has declined, but the incidence of sequelae is still high. There have been reports in foreign countries that the mortality rate of the acute phase of purulent meningitis in 80s is 22%. With the development of medical technology, it declined to 6.6% in 90s, and the incidence of sequelae of the nervous system changed very little in the ten years. It was still up to 25.5% and 23.5%[1]. viral encephalitis, such as herpes simplex encephalitis, enteroviral encephalitis, and insect borne encephalitis, rapid progress, great harm, and most of the sequelae. Therefore, early diagnosis of suppurative meningitis and viral encephalitis is the key to the prognosis. However, due to the widespread use of antibiotics, the brain and brain are not easily identified from the appearance, routine, and biochemistry of the cerebrospinal fluid. Therefore, in recent years, the study of the immune mechanism of the central nervous system infection in the brain seeks to identify pyogenic meningitis and to identify the suppurative meningitis. The simple and feasible method of viral encephalitis has become a hot spot. This study compares the concentrations of P (Substance P, SP), interleukin 17 (Interleukin-17, IL-17), and IL-6 (Interleukin-6, IL-6) in the cerebrospinal fluid of children with acute cerebral and brain disease, and compares the expression level of these markers in the early brain and the brain, and discusses its clinical significance. And related immunological mechanisms to provide a theoretical basis for the clinical identification of the brain and the brain. The study selected 23 children, 15 men, 8 women, 1 months of age and 6 months (2.3 + 1.7) years of age, 1 months of age, 6 months (2.3 + 1.7) years, in our hospital in December 2014 -2016. 25 children, 16 males and 9 females, aged 3 months -8 (3.7 + 2.4) years old, and 30 cases in the control group, 19 males, 11 cases, 3 months -6 years old (2.6 + 1.8) years old in the control group, were diagnosed as the sick brain (the diagnostic standard conforms to the seventh edition of the seventh edition of Paediatrics). The age, sex, weight, and so on of the children in the group.3 of children without immune deficiency in the same period were excluded. The basic situation was not statistically significant (P0.05). The children of group.3 were all lumbar puncture in 24h after admission, and CSF 5ml was collected, and 3ml was sent to the laboratory for biochemistry, routine, three staining, 2ml in the aseptic EP tube, and stored at -80. The SPSS 21 statistical package was used to deal with the alpha =0.05 as the test standard. Results the level of SP in the brain group, the disease brain group and the control group was (1176.33 + 249.03) ug/L, (562.57 + 40.81) ug/L, (95.60 + 43.50) ug/L, IL-17 level (463.54 + 152.05) ug/L, (59.46 + 26.12) ug/L, (8.87 + 5.96) ug/L, IL-6 levels were respectively G/L, (132.81 + 39.78) ug/L, (6.62 + 2.02) ug/L, 3 index differences between the three groups were statistically significant (P0.05). 22 compared with each group, there were statistical differences (P0.05). The average of SP, IL-17, IL-6 water in the brain group CSF was significantly higher than that of the disease brain group and the control group, CSF SP, IL-17, and water were significantly higher than the control group. Conclusion 1. In the acute phase of purulent meningitis and viral encephalitis, the expression of substance P, IL-17, IL-6 in cerebrospinal fluid is higher, and the higher of the suppurative meningitis group is that the P substance in the cerebrospinal fluid of the children with the acute phase of the.2. central nervous system infection, IL-17, IL-6 may be involved in the development of the disease, and can be used as a reference finger to identify the brain and the brain to a certain extent. Mark.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

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