摘要
目的 观察化脓性脑膜炎(PM)、结核性脑膜炎(TBM)患者脑脊液中乳酸脱氢酶(LDH)、肌酸激酶(CK)、神经元特异性烯醇化酶(NSE)水平的差异,并分析三项指标在PM、TBM鉴别中的价值.方法 将2019年12月至2021年12月就诊于衡水市人民医院神经内科的35例PM患者纳入PM组,45例TBM患者作为TBM组.采集患者治疗前的脑脊液样本,测定并对比两组脑脊液中LDH、CK、NSE水平及糖、蛋白、氯化物含量,经Pearson分析脑脊液中指标间相关性.线性回归分析影响TBM发生的因素,绘制受试者工作特征(ROC)曲线评估脑脊液中LDH、CK、NSE及联合对PM与TBM的鉴别价值.结果 年龄、性别、临床特征(发热、病理征、呕吐、肢体抽搐等)发生率、脑脊液中糖与蛋白含量两组差异无统计学意义(P＞0.05);TBM组脑脊液中LDH、NSE水平高于PM组,CK水平、氯化物含量低于PM组(P＜0.05);Pearson相关性显示,脑脊液中LDH与CK、氯化物呈负相关(r＜0,P＜0.05),与NSE呈正相关(r＞0,P＜0.05);CK与NSE呈负相关(r＜0,P＜0.05),与氯化物呈正相关(r＞0,P＜0.05);NSE与氯化物呈负相关(r＜0,P＜0.05);线性回归分析显示,脑脊液中LDH、CK、NSE、氯化物均与TBM的发生相关(P＜0.05);ROC曲线结果发现,脑脊液中LDH、CK、NSE 及三者联合鉴别 PM、TBM 的AUC为 0.849(95％CI:0.768～0.930)、0.858(95％CI:0.779～0.937)、0.851(95％CI:0.771～0.931)、0.954(95％CI:0.911～0.996).结论 PM、TBM 患者临床特征相似,但脑脊液中 LDH、CK、NSE水平存在差异,三项指标联合检测可提高PM与TBM的鉴别诊断.
Abstract
Objective To compare the differences in the levels of lactate dehydrogenase(LDH),creatine kinase(CK),and neuron-specific enolase(NSE)in the cerebrospinal fluid(CSF)between the patients with purulent meningitis(PM)and those with tuberculous meningitis(TBM)and evaluate the utility of the three biomarkers in the differentiation of PM and TBM.Methods Thirty-five PM patients and 45 TBM patients who attended the Department of Neurology from December 2019 to December 2021 were enrolled in this study.The CSF samples were collected from the patients before treatment.The levels of LDH,CK,NSE,and glucose,protein,and chloride in CSF were measured and compared between PM and TBM patients.The correlation between the biomarkers in CSF was analyzed by Pearson correlation coefficient.Linear regression analysis was performed to analyze the risk factors for the occurrence of TBM.Receiver operating characteristic(ROC)curves were plotted to evaluate the discriminative value of CSF LDH,CK,NSE alone or in combination in differential diagnosis of PM and TBM.Results Patient age,gender,clinical features such as fever,pathological signs,vomiting,limb twitching,and CSF levels of glucose and protein did not show significant difference between TBM patients and PM patients(P＞0.05).TBM was associated with significantly higher LDH and NSE levels in CSF and significantly lower CK level and chloride in CSF compared to PM(P＜0.05).Pearson correlation analysis showed that LDH level in CSF was negatively correlated with CK and chloride(r＜0,P＜0.05),and positively correlated with NSE(r＞0,P＜0.05).CK was negatively correlated with NSE(r＜0,P＜0.05),and positively correlated with chloride(r＞0,P＜0.05).NSE was negatively correlated with chloride(r＜0,P＜0.05).Linear regression analysis showed that LDH,CK,NSE,and chloride levels in CSF were all associated with the occurrence of TBM(P＜0.05).ROC curves demonstrated that the AUCs of CSF levels of LDH,CK,NSE alone and in combination for differentiation between PM and TBM were 0.849(95％CI:0.768-0.930),0.858(95％CI:0.779-0.937),0.851(95％CI:0.771-0.931),and 0.954(95％CI:0.911-0.996),respectively.Conclusions The clinical features are similar for PM and TBM patients.However,the levels of LDH,CK,and NSE in CSF are different between PM and TBM.LDH,CK,NSE in combination may improve the differential diagnosis between PM and TBM.
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