CRP、降钙素原及铁蛋白水平在儿童脑膜炎脑脊液中的诊断价值

Diagnostic Value of CRP, Procalcitonin, and Ferritin Levels in Cerebrospinal Fluid of Children with Meningitis.

作者信息

Shokrollahi Mohammad R, Shabanzadeh Khalil, Noorbakhsh Samileh, Tabatabaei Azardokht, Movahedi Zahra, Shamshiri Ahmad R

机构信息

Research Center of Pediatric Infectious Diseases, Qom University of Medical Sciences and Health services, Qom, Iran.

Research Center of Pediatric Infectious Diseases, Iran University of Medical science, Tehran, Iran.

出版信息

Cent Nerv Syst Agents Med Chem. 2018 Jan 26;18(1):58-62. doi: 10.2174/1871524916666160302103223.

DOI:10.2174/1871524916666160302103223

PMID:26931764

Abstract

BACKGROUND AND OBJECTIVE

Bacterial meningitis is a serious disease with high rate of mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation, which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers can help the physicians to differentiate between bacterial and aseptic meningitis. In the current study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin, were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis.

METHODS

In a prospective cross sectional study in a referral children hospital in Tehran during 2011- 2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two groups, children with bacterial and aseptic meningitis. The cut-offs of biomarker levels for differentiation between the 2 groups were constructed by receiver-operating - characteristic curve (ROC).

RESULTS

57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were significantly higher than in aseptic meningitis (P values=˂0.001, 0.001, ˂0.001respectively), with sensitivity/ specificity being 92.9% / 68%, 92.9% / 84%, and 96.4% / 80%, respectively. Positive Predictive Values (PPV) were, correspondingly, 96.4%, 92.8%, and 92.8% for procalcitonin, Ferritin, and CRP. Corresponding Negative Predictive Values (NPV) were, respectively equal to 95.4%, 70%, and 88%.

CONCLUSION

CSF of children with bacterial meningitis contains higher levels of inflammatory mediators including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate treatment.

摘要

背景与目的

细菌性脑膜炎是一种严重疾病，在儿童中死亡率和发病率很高。病原体入侵会导致脑和脑膜炎症，进而使生物标志物释放到脑脊液（CSF）中。识别这些生物标志物有助于医生区分细菌性脑膜炎和无菌性脑膜炎。在本研究中，对细菌性和无菌性脑膜炎患者脑脊液中的一些生物标志物，如降钙素原、C反应蛋白（CRP）和铁蛋白进行了比较。

方法

在2011年至2013年期间于德黑兰一家转诊儿童医院开展的一项前瞻性横断面研究中，对57例临床疑似脑膜炎儿童的脑脊液降钙素原、铁蛋白和CRP水平进行了测量。采用曼-惠特尼U检验和卡方检验对细菌性和无菌性脑膜炎两组儿童进行比较。通过受试者操作特征曲线（ROC）构建两组间生物标志物水平的区分临界值。

结果

本调查纳入了57名受试者（30例细菌性脑膜炎和27例无菌性脑膜炎）。在比较两组时，细菌性脑膜炎患者脑脊液中铁蛋白、CRP和降钙素原水平显著高于无菌性脑膜炎患者（P值分别为˂0.001、0.001、˂0.001），敏感性/特异性分别为92.9% / 68%、92.9% / 84%和96.4% / 80%。降钙素原、铁蛋白和CRP的阳性预测值（PPV）分别相应为96.4%、92.8%和92.8%。相应的阴性预测值（NPV）分别等于95.4%、70%和88%。