血清CysC联合MMP-9在小儿病毒性脑炎病情判断及预后评估中的应用价值
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摘要
目的分析血清CysC联合MMP-9在小儿病毒性脑炎病情判断及预后评估中的应用价值。方法选择2017年1月至2018年10月接诊的138例小儿病毒性脑炎患儿作为病例组,另选60例同期的健康体检小儿作为对照组,检测病例组入院时及出院时,对照组体检当日的血清CysC、MMP-9;比较病例组入院时与对照组血清CysC、MMP-9水平,观察病例组入院时与出院时,重症与非重症患儿的血清CysC、MMP-9差异情况,采用Pearson相关性分析小儿病毒性脑炎患儿入院时血清CysC水平与MMP-9水平的相关性;随访6个月,以神经系统后遗症作为随访指标,采用ROC曲线分析血清CysC联合MMP-9预测神经系统后遗症的效能。结果病例组入院时血清CysC、MMP-9水平均明显高于对照组,差异均有统计学意义(P<0.05);病例组出院时CysC、MMP-9水平均较入院时明显降低,差异均有统计学意义(P<0.05);在病例组138例患儿中,重症组入院时血清CysC、MMP-9水平均明显高于非重症组,差异均有统计学意义(P<0.05);小儿病毒性脑炎患儿血清CysC水平与MMP-9水平呈正相关(r=0.233,P=0.006),线性相关较好;随访6个月,共37例患儿存在神经系统后遗症,CysC联合MMP-9预测小儿病毒性脑炎患儿发生神经系统后遗症的ROC曲线下面积(AUC)为0.850,明显大于CysC的0.625或MMP-9的0.605,差异均有统计学意义(P<0.05)。结论小儿病毒性脑炎患儿病情严重程度与血清CysC、MMP-9水平有关,两者联合检测可协同提高对神经系统后遗症的预测效能,值得进一步研究应用。
Objective To analyze the application value of serum CysC combined with MMP9 in diseases condition judgment and prognosis evaluation in infants with viral encephalitis.Methods A total of 138 infants with viral encephalitis, who were admitted and treated in our hospital from January 2017 to October 2018, were enrolled as case group,at the same time,60 healthy children were enrolled as control group. The levels of serum CysC and MMP-9 of the patients at admission and discharge and those of the infants in control group on the inspection day were detected. Moreover, the levels of serum CysC and MMP-9 of the patients at admission were compared with those of the infants in control group. And the differences of serum levels of CysC and MMP-9 between severe cases and common cases at admission and in discharging from hospital in case group were observed and compared. Pearson correlation analysis was used to analyze the correlation between the serum levels of CysC and those of MMP-9 in patients at admission. Furthermore, all the patients were followed up for six months, with neurological sequelae being used as observation index. In addition, ROC curve was used to analyze the efficacy of serum CysC combined with MMP-9 in predicting neurological sequelae.Results The levels of serum CysC and MMP-9 of the patients at admission in case group were significantly higher than those in control group(P<0.05). The serum levels of CysC and MMP-9 in case group in discharging from hospital were significantly decreased(P<0.05). Among the 138 patients in case group, the levels of serum CysC and MMP-9 in severe case group at admission were significantly higher than those in non-severe case group(P<0.05). Moreover, the serum levels of CysC were positively correlate with those of MMP-9 in infants with viral encephalitis(r=0.233, P<0.01).Thirty-seven patients developed neurological sequelae at the follow-up. In addition, the areas under the ROC curve(AUC) to predict neurological sequelae using CysC combined with MMP-9 was 0.850, which was markedly larger than those when using CysC(0.625) and MMP-9(0.605) alone(P<0.05). Conclusion The severity of infants with is correlated with the levels of serum CysC and MMP-9. The combination detection of the two indexes can improve the efficiency of predicting neurological sequelae, which is worthy of further research.
Objective To analyze the application value of serum CysC combined with MMP9 in diseases condition judgment and prognosis evaluation in infants with viral encephalitis.Methods A total of 138 infants with viral encephalitis, who were admitted and treated in our hospital from January 2017 to October 2018, were enrolled as case group,at the same time,60 healthy children were enrolled as control group. The levels of serum CysC and MMP-9 of the patients at admission and discharge and those of the infants in control group on the inspection day were detected. Moreover, the levels of serum CysC and MMP-9 of the patients at admission were compared with those of the infants in control group. And the differences of serum levels of CysC and MMP-9 between severe cases and common cases at admission and in discharging from hospital in case group were observed and compared. Pearson correlation analysis was used to analyze the correlation between the serum levels of CysC and those of MMP-9 in patients at admission. Furthermore, all the patients were followed up for six months, with neurological sequelae being used as observation index. In addition, ROC curve was used to analyze the efficacy of serum CysC combined with MMP-9 in predicting neurological sequelae.Results The levels of serum CysC and MMP-9 of the patients at admission in case group were significantly higher than those in control group(P<0.05). The serum levels of CysC and MMP-9 in case group in discharging from hospital were significantly decreased(P<0.05). Among the 138 patients in case group, the levels of serum CysC and MMP-9 in severe case group at admission were significantly higher than those in non-severe case group(P<0.05). Moreover, the serum levels of CysC were positively correlate with those of MMP-9 in infants with viral encephalitis(r=0.233, P<0.01).Thirty-seven patients developed neurological sequelae at the follow-up. In addition, the areas under the ROC curve(AUC) to predict neurological sequelae using CysC combined with MMP-9 was 0.850, which was markedly larger than those when using CysC(0.625) and MMP-9(0.605) alone(P<0.05). Conclusion The severity of infants with is correlated with the levels of serum CysC and MMP-9. The combination detection of the two indexes can improve the efficiency of predicting neurological sequelae, which is worthy of further research.
引文
1 韩钊定,郭萍,杜永国,等.儿童中枢神经系统感染行脑CT检查的价值分析.中华医院感染学杂志,2017,27:915-918.
2 González S,Carbonaro M,Fedullo AG,et al.Cerebrospinal fluid shunt-associated infections in pediatrics:Analysis of the epidemiology and mortality risk factors.Archivos Argentinos De Pediatría,2018,116:198-203.
3 Moshe A,Izraely S,Sagiassif O,et al.Cystatin C takes part in melanoma-microglia cross-talk:possible implications for brain metastasis.Clinical & Experimental Metastasis,2018,35:1-10.
4 卢文玉,唐玉兰,李一锋,等.载脂蛋白E对星形胶质细胞基质金属蛋白酶-9表达的作用及机制研究.中华神经医学杂志,2017,16:349.
5 胡亚美,江载芳主编.诸福棠实用儿科学.第7版.北京:人民卫生出版社,2002.759-766.
6 Mwangome M,Ngari M,Fegan G,et al.Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.American Journal of Clinical Nutrition,2017,105:1415-1423.
7 Mmj AO,Bahadoran A,Wang SM,et al.Disruption of the blood brain barrier is vital property of neurotropic viral infection of the central nervous system.Acta Virologica,2018,62:16.
8 李春雷,张峰.醒脑静注射液联合银杏叶提取物注射液对老年急性脑梗死病人MMP-9、BNP及Cys-C的影响.中西医结合心脑血管病杂志,2017,15:1435-1438.
9 Spampinato SF,Merlo S,Sano Y,et al.Astrocytes contribute to Aβ-induced blood brain barrier damage through activation of endothelial MMP9.Journal of Neurochemistry,2017,142:464-477.
10 于翔,温慧军.急性脑梗死患者颈动脉粥样硬化斑块与胱抑素C及载脂蛋白B水平的关系.中风与神经疾病杂志,2018,35:317-319.
11 王家驷,宋毅.脑脊液CysC及mpt在多种神经系统疾病中的动态表达及变化趋势分析.检验医学与临床,2017,14:1441-1444.
12 Compton Jaimee R,Mickey Matthew J,Hu Xin,et al.Mutation of Asn-475 in the Venezuelan Equine Encephalitis Virus nsP2 Cysteine Protease Leads to a Self-Inhibited State.Biochemistry,2017,56:6221-6230.
13 陈萌,田焕娜,吴晓光,等.半胱氨酸蛋白酶抑制剂C对脑缺血再灌注大鼠Bcl-2、Bax和Beclin-1的表达及细胞凋亡的影响.解剖学杂志,2017,40:417-420.
14 Mori D,Khanam W,Sheikh RA,et al.Increased serum vascular endothelial growth factor is associated with acute viral encephalitis in Bangladeshi children.Sci Rep,2017,7:16181.
15 Wu D,Feng M,Wang ZX,et al.Molecular and biochemical characterization of key enzymes in the cysteine and serine metabolic pathways of Acanthamoeba castellanii.Parasites & Vectors,2018,11:604.
16 Hu X,Compton JR,Leary DH,et al.Kinetic,Mutational,and Structural Studies of the Venezuelan Equine Encephalitis Virus Nonstructural Protein 2 Cysteine Protease.Biochemistry,2015,55:3007-3019.
17 卢文玉,唐玉兰,李一锋,等.载脂蛋白E对星形胶质细胞基质金属蛋白酶-9表达的作用及机制研究.中华神经医学杂志,2017,16:349.
18 李军霞,赵青,何红彦,等.基质金属蛋白酶-9与血脑屏障和结核性脑膜炎.中国感染与化疗杂志,2017,17:463-467.
19 吴彪,艾戎,杨志晓,等.病毒性脑炎患儿血清和脑脊液中MMPs与TIMP和PCT及TNF-α指标检测价值研究.中华医院感染学杂志,2017,27:2118-2121.
20 Ni Y,Ye X,Wan C,et al.Percutaneous microwave ablation (MWA) increased the serum levels of VEGF and MMP-9 in Stage I non-small cell lung cancer (NSCLC).International Journal of Hyperthermia,2017,33:435-439.
21 矫淑芹.化脓性脑膜炎、病毒性脑炎血清及脑脊液中IL-1β和MMP-9水平的差异及其临床意义.海南医学院学报,2016,22:178-181.
22 张楠,张中馥,徐丽娟,等.病毒性脑炎患儿脑脊液变化及血清学相关指标的临床意义.河北医药,2018,40:3745-3747,3752.
23 Ong CWM,Pabisiak PJ,Brilha S,et al.Complex regulation of neutrophil-derived MMP-9 secretion in central nervous system tuberculosis.Journal of Neuroinflammation,2017,14:31.
24 陈易简,徐运.血脑屏障完整性与中枢神经系统疾病的发展和转归的相关性研究进展.国际神经病学神经外科学杂志,2017,44:319-322.
2 González S,Carbonaro M,Fedullo AG,et al.Cerebrospinal fluid shunt-associated infections in pediatrics:Analysis of the epidemiology and mortality risk factors.Archivos Argentinos De Pediatría,2018,116:198-203.
3 Moshe A,Izraely S,Sagiassif O,et al.Cystatin C takes part in melanoma-microglia cross-talk:possible implications for brain metastasis.Clinical & Experimental Metastasis,2018,35:1-10.
4 卢文玉,唐玉兰,李一锋,等.载脂蛋白E对星形胶质细胞基质金属蛋白酶-9表达的作用及机制研究.中华神经医学杂志,2017,16:349.
5 胡亚美,江载芳主编.诸福棠实用儿科学.第7版.北京:人民卫生出版社,2002.759-766.
6 Mwangome M,Ngari M,Fegan G,et al.Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.American Journal of Clinical Nutrition,2017,105:1415-1423.
7 Mmj AO,Bahadoran A,Wang SM,et al.Disruption of the blood brain barrier is vital property of neurotropic viral infection of the central nervous system.Acta Virologica,2018,62:16.
8 李春雷,张峰.醒脑静注射液联合银杏叶提取物注射液对老年急性脑梗死病人MMP-9、BNP及Cys-C的影响.中西医结合心脑血管病杂志,2017,15:1435-1438.
9 Spampinato SF,Merlo S,Sano Y,et al.Astrocytes contribute to Aβ-induced blood brain barrier damage through activation of endothelial MMP9.Journal of Neurochemistry,2017,142:464-477.
10 于翔,温慧军.急性脑梗死患者颈动脉粥样硬化斑块与胱抑素C及载脂蛋白B水平的关系.中风与神经疾病杂志,2018,35:317-319.
11 王家驷,宋毅.脑脊液CysC及mpt在多种神经系统疾病中的动态表达及变化趋势分析.检验医学与临床,2017,14:1441-1444.
12 Compton Jaimee R,Mickey Matthew J,Hu Xin,et al.Mutation of Asn-475 in the Venezuelan Equine Encephalitis Virus nsP2 Cysteine Protease Leads to a Self-Inhibited State.Biochemistry,2017,56:6221-6230.
13 陈萌,田焕娜,吴晓光,等.半胱氨酸蛋白酶抑制剂C对脑缺血再灌注大鼠Bcl-2、Bax和Beclin-1的表达及细胞凋亡的影响.解剖学杂志,2017,40:417-420.
14 Mori D,Khanam W,Sheikh RA,et al.Increased serum vascular endothelial growth factor is associated with acute viral encephalitis in Bangladeshi children.Sci Rep,2017,7:16181.
15 Wu D,Feng M,Wang ZX,et al.Molecular and biochemical characterization of key enzymes in the cysteine and serine metabolic pathways of Acanthamoeba castellanii.Parasites & Vectors,2018,11:604.
16 Hu X,Compton JR,Leary DH,et al.Kinetic,Mutational,and Structural Studies of the Venezuelan Equine Encephalitis Virus Nonstructural Protein 2 Cysteine Protease.Biochemistry,2015,55:3007-3019.
17 卢文玉,唐玉兰,李一锋,等.载脂蛋白E对星形胶质细胞基质金属蛋白酶-9表达的作用及机制研究.中华神经医学杂志,2017,16:349.
18 李军霞,赵青,何红彦,等.基质金属蛋白酶-9与血脑屏障和结核性脑膜炎.中国感染与化疗杂志,2017,17:463-467.
19 吴彪,艾戎,杨志晓,等.病毒性脑炎患儿血清和脑脊液中MMPs与TIMP和PCT及TNF-α指标检测价值研究.中华医院感染学杂志,2017,27:2118-2121.
20 Ni Y,Ye X,Wan C,et al.Percutaneous microwave ablation (MWA) increased the serum levels of VEGF and MMP-9 in Stage I non-small cell lung cancer (NSCLC).International Journal of Hyperthermia,2017,33:435-439.
21 矫淑芹.化脓性脑膜炎、病毒性脑炎血清及脑脊液中IL-1β和MMP-9水平的差异及其临床意义.海南医学院学报,2016,22:178-181.
22 张楠,张中馥,徐丽娟,等.病毒性脑炎患儿脑脊液变化及血清学相关指标的临床意义.河北医药,2018,40:3745-3747,3752.
23 Ong CWM,Pabisiak PJ,Brilha S,et al.Complex regulation of neutrophil-derived MMP-9 secretion in central nervous system tuberculosis.Journal of Neuroinflammation,2017,14:31.
24 陈易简,徐运.血脑屏障完整性与中枢神经系统疾病的发展和转归的相关性研究进展.国际神经病学神经外科学杂志,2017,44:319-322.
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