Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Department of Pediatrics, Wonju Severance Christian Hospital Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Pediatr Neonatol. 2021 May;62(3):305-311. doi: 10.1016/j.pedneo.2021.02.002. Epub 2021 Feb 23.
Enteroviral meningitis is typically diagnosed as the presence of pleocytosis and of viral RNA in cerebrospinal fluid. However, it was recently reported that more than 50% of infants with enteroviral meningitis diagnosed by polymerase chain reaction had no cerebrospinal fluid pleocytosis. This study investigated type I interferon (IFN) and cytokine profiles in the cerebrospinal fluid based on the presence or absence of cerebrospinal fluid pleocytosis in children with enteroviral meningitis.
We included 51 enteroviral meningitis patients showing cerebrospinal fluid pleocytosis (pleocytosis group), 31 enteroviral meningitis patients without cerebrospinal fluid pleocytosis (non-pleocytosis group), and 52 controls (control group) and compared cerebrospinal fluid interleukin 6 (IL-6), IL-8, chemokine (C-X-C motif) ligand 10 (CXCL-10), IFN-α, and IFN-β levels.
A significant difference was observed in IL-6, IL-8, and CXCL-10 levels across the three groups, with highest values in the pleocytosis patients, followed by those in the non-pleocytosis and control subjects. IFN-α level was higher in the pleocytosis group than in the non-pleocytosis and control groups. Meanwhile, the IFN-β level was higher in the pleocytosis and non-pleocytosis groups than in the control group (34.54 [31.23-38.59] pg/mL vs. 33.21 [31.23-35.21] pg/mL vs. 0.00 [0.00-0.00] pg/mL, respectively; P < 0.001). Furthermore, cerebrospinal fluid IFN-β was detected in all patients with enteroviral meningitis, except one (98.8%) regardless of pleocytosis, whereas it was detected in only two (3.8%) control subjects (P < 0.001).
The cerebrospinal fluid cytokine profiles remarkably differed based on the presence or absence of cerebrospinal fluid pleocytosis. Further investigations are required to determine whether cerebrospinal fluid IFN-β could be used as a surrogate marker of viral meningitis instead of cerebrospinal fluid pleocytosis.
肠病毒性脑膜炎通常通过脑脊液中的白细胞增多和病毒 RNA 的存在来诊断。然而，最近有报道称，通过聚合酶链反应诊断为肠病毒性脑膜炎的婴儿中，超过 50%的患者脑脊液中没有白细胞增多。本研究根据儿童肠病毒性脑膜炎脑脊液中白细胞增多的存在与否，研究了Ⅰ型干扰素（IFN）和细胞因子谱。
我们纳入了 51 例脑脊液白细胞增多的肠病毒性脑膜炎患者（白细胞增多组）、31 例脑脊液白细胞增多的肠病毒性脑膜炎患者（无白细胞增多组）和 52 例对照（对照组），并比较了脑脊液中白细胞介素 6（IL-6）、IL-8、趋化因子（C-X-C 基序）配体 10（CXCL-10）、IFN-α和 IFN-β 的水平。
三组之间的 IL-6、IL-8 和 CXCL-10 水平存在显著差异，白细胞增多组的水平最高，其次是无白细胞增多组和对照组。IFN-α水平在白细胞增多组高于无白细胞增多组和对照组。同时，白细胞增多组和无白细胞增多组的 IFN-β水平高于对照组（34.54[31.23-38.59]pg/mL 比 33.21[31.23-35.21]pg/mL 比 0.00[0.00-0.00]pg/mL，P<0.001）。此外，除 1 例外（98.8%），所有肠病毒性脑膜炎患者的脑脊液中均检测到 IFN-β（除外 1 例外），而对照组仅检测到 2 例（3.8%）（P<0.001）。
脑脊液细胞因子谱根据脑脊液白细胞增多的存在与否有显著差异。需要进一步研究以确定脑脊液 IFN-β是否可替代脑脊液白细胞增多作为病毒脑膜炎的替代标志物。
