Objective To study the level of cerebrospinal fluid(CSF)secretory CD163(sCD163),α alpha 2 macro-globulin(A2M)in children with acute purulent meningitis(PM)and correlation with poor prognosis.Methods To investi-gate the levels of sCD163 and A2M in cerebrospinal fluid of children with acute purulent meningitis(PM)and their relation-ship with poor prognosis.A total of 114 children with PM who were diagnosed and treated in the Department of Pediatrics,Hainan Hospital Affiliated to Hainan Medical College/Hainan Provincial People's Hospital from January 2020 to January 2022 were enrolled as the PM group.According to the degree of central nervous system dysfunction,they were divided into se-vere subgroup(n=38)and general subgroup(n=76).According to the Glasgow outcome Scale at 6 months after discharge,the patients were divided into good prognosis subgroup(n=84)and poor prognosis subgroup(n=30).A total of 60 chil-dren with viral meningitis(VM)who were diagnosed and treated during the same period were enrolled as VM group,and 60 children with non-infectious diseases of the central nervous system were enrolled as control group.Enzyme-linked immu-nosorbent assay was used to measure the levels of sCD163 and A2M in cerebrospinal fluid.Logistic regression was used to analyze the prognostic factors of PM.Receiver operating characteristic curve was used to analyze the value of cerebrospinal fluid sCD163 and A2M in evaluating the prognosis of PM.Results The levels of sCD163 and A2M in cerebrospinal fluid of PM group were higher than those of VM group and control group(F/P=1522.470/＜0.001,1487.801/＜0.001).The chil-dren in the severe subgroup had significantly higher levels of sCD163 and A2M in cerebrospinal fluid than those in the gener-al subgroup(t/P=17.900/＜0.001,14.896/＜0.001).The proportion of children with shock and the levels of WBC,CRP,sCD163,and A2M in cerebrospinal fluid in the poor prognosis subgroup were significantly higher than those in the good prognosis subgroup(t/P=4.878/0.027,7.612/＜0.001,16.100/＜0.001,9.522/＜0.001,20.939/＜0.001).Shock,cerebrospinal fluid WBC,cerebrospinal fluid CRP,cerebrospinal fluid sCD163,and cerebrospinal fluid A2M were risk factors for poor prognosis in children with PM[OR(95％CI)=1237(1.054-1.453),1.172(1.104-1355),1202(1208-1.406);1.210(1.057-1.386),1.156(1.040-1285)];The area under the curve(AUC)of the combination of cerebrospinal fluid CSF sCD163 and A2M in the di-agnosis of PM was 0.929,which was larger than 0.880 and 0.841 predicted by CSF sCD163 or A2M alone(Z=4.572,5.358,all P＜0.001).Conclusion The levels of sCD163 and A2M in cerebrospinal fluid of children with PM are abnormally increased,and they are related to the severity of the disease.The combination of scD163 and A2M has a high predictive value for the poor prognosis of children with PM.
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