摘要
目的探讨血清髓鞘碱性蛋白(MBP)、降钙素基因相关肽(CGRP)、腺苷脱氨酶(ADA)及肌酸激酶脑型同工酶(CK-BB)在化脓性脑膜炎中的表达及意义。方法选择2017年5月至2019年5月聊城市人民医院接诊的100例化脓性脑膜炎为本研究对象,设为观察组,另选择同期在山东省聊城市人民医院体检的75例健康人群作为对照组,分析血清MBP、CGRP、ADA及CK-BB水平变化情况,及其诊断价值。结果观察组患者血清MBP、CGRP、ADA及CK-BB水平(12.75±2.74μg·L^-1、77.16±27.15 ng·mL^-1、8.41±2.52 U·L^-1、15.47±4.71U·L^-1)显著高于对照组(6.45±2.71μg·L^-1、16.15±4.91ng·mL^-1、6.16±2.56U·L^-1、4.41±0.76U·L^-1),差异显著(P<0.05);危重症组患者血清MBP、CGRP、ADA及CK-BB水平(15.53±2.69μg·L^-1、92.59±28.79ng·mL^-1、9.35±2.59U·L^-1、18.31±5.09U·L^-1)均显著高于重症组(12.81±2.81μg·L^-1、78.53±27.54ng·mL^-1、8.43±2.58U·L^-1、15.62±4.78U·L^-1)、轻症组(10.25±2.69μg·L^-1、61.86±25.19ng·mL^-1、7.56±2.37U·L^-1、12.79±4.28U·L^-1)患者,差异显著(P<0.05);重症组患者血清MBP、CGRP、ADA及CK-BB水平均显著高于轻症组患者,差异显著(P<0.05);MBP诊断化脓性脑膜炎的AUC为0.930,95%CI为0.894~0.967,CGRP诊断化脓性脑膜炎的曲线下面积(area under the cure,AUC)为0.846,95%CI为0.787~0.905,ADA诊断化脓性脑膜炎的AUC为0.714,95%CI为0.637~0.790,CK-BB诊断化脓性脑膜炎的AUC为0.851,95%CI为0.795~0.907,联合检测诊断化脓性脑膜炎的AUC为0.992,95%CI为0.982~1.000,单独检测分别和联合检测曲线下面积比较均具有显著差异(Z=3.156、4.801、7.070、4.791,均P<0.05);联合检测的特异度、准确度分别为93.19%、94.59%。结论在化脓性脑膜炎中血清MBP、CGRP、ADA及CK-BB的表达和病情严重程度之间存在着密切关系,且联合检测在诊断化脓性脑膜炎时具有较高的准确度,可作为诊断化脓性脑膜炎的重要指标,可为靶向药物治疗化脓性脑膜炎提供新思路。
Objective To study analysis of the expression and significance of serum myelin basic protein(myelin basic protein,MBP),Calcitonin gene related peptide(calcitonin gene related peptide,CGRP),adenosine deaminase(adenosine deaminase,ADA)and creatine kinase isozyme brain type(creatine kinase isoenzymes,CK-BB)in purulent meningitis.Methods 100 cases of suppurative meningitis admitted to our hospital from May 2017to May 2019 were selected as the objects of this study and were set as the observation group,in addition,75 healthy patients who underwent physical examination in our hospital during the same period were selected as the control group to analyze the changes of serum MBP,CGRP,ADA and CK-BB levels and their diagnostic value.Results The serum levels of MBP,CGRP,ADA and CK-BB in the observation group(12.75±2.74 mu·L^-1,77.16±27.15 ng·mL^-1,8.41±2.52 U·L^-1,15.47±4.71U·L^-1)were significantly higher than those in the control group(6.45±2.71 mu·L^-1,16.15±4.91ng·mL^-1,6.16±2.56U·L^-1,4.41±0.76U·L^-1),with significant differences(P<0.05).Serum from critically ill patients The levels of MBP,CGRP,ADA and CK-BB(15.53±2.69 mu·L^-1,92.59±28.79ng·mL^-1,9.35±2.59U·L^-1,18.31±5.09U·L^-1)were significantly higher than those of the severe group(12.81±2.81mu·L^-1,78.53±27.54ng·mL^-1,8.43±2.58U·L^-1,15.62±4.78U·L^-1)and the mild group(10.25±2.69 mu·L^-1,61.86±25.19ng·mL^-1,7.56±2.37U·L^-1,1279±4.28U·L^-1)(P<0.05).Serum MBP,CGRP,ADA and CK-BB levels in the severe group were significantly higher than those in the mild group(P<0.05).The AUC for MBP diagnosis of suppurative meningitis was 0.930,95%CI was 0.894-0.967,the AUC for CGRP diagnosis of purulent meningitis was0.846,95%CI was 0.787-0.905,the AUC for ADA diagnosis of purulent meningitis was 0.714,95%CI was 0.637-0.790,the AUC for ck-bb diagnosis of purulent meningitis was 0.851,95%CI was 0.795-0.907,and the AUC for combined detection of purulent meningitis was 0.992.The 95%CI ranged from 0.982 to 1.000,and there were significant differences between the area under the curve tested separately and under the curve tested jointly(Z=3.156,4.801,7.070,4.791,P<0.05).The specificity and accuracy of the joint test were 93.19%and 94.59%respectively.conclusion There is a close relationship between the expression of serum MBP,CGRP,ADA and cc-bb and the severity of the disease in purulent meningitis,and the combined detection has high accuracy in the diagnosis of purulent meningitis,which can be used as an important indicator in the diagnosis of purulent meningitis,and can provide a new idea for targeted drug therapy of purulent meningitis.
作者
程卫东
王纪敏
Cheng Weidong;Wang Jimin(Department of Neurology,the Liaocheng People's Hospital,Shandong 252000,China)
出处
《脑与神经疾病杂志》
2020年第8期490-493,共4页
Journal of Brain and Nervous Diseases
基金
山东省自然科学基金(ZR2013H1016)
