目的:分析血清与脑脊液神经元特异性烯醇化酶（neuron specific enolase，NSE）、可溶性白介素-2受体（soluble interleukin -2 receptor，SIL-2R）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平在小儿病毒性脑膜炎与细菌性脑膜炎中的诊断价值。方法:收集2019年1月~2020年12月海南省妇女儿童医学中心收治的57例病毒性脑膜炎和43例细菌性脑膜炎，共100例中枢神经系统感染的患儿，另选取同期于我院行血清及脑脊液且无中枢神经感染的42例患儿为对照组。检测血清及脑脊液NSE、SIL-2R、TNF-α水平，通过ROC曲线分析各项指标对小儿中枢神经系统感染的诊断效能。结果:病毒性脑膜炎组和细菌性脑膜炎组患儿血清及脑脊液NSE、SIL-2R、TNF-α水平均高于对照组，差异具有统计学意义（P＜0.05）；细菌性脑膜炎组患儿血清及脑脊液NSE、SIL-2R、TNF-α水平均高于病毒性脑膜炎组，差异具有统计学意义（P＜0.05）。血清NSE、SIL-2R、TNF-α单独诊断小儿中枢神经系统感染的AUC分别为0.707、0.762、0.629，敏感度为73.19%、71.94%、74.35%，特异度为80.92%、81.35%、86.26%；联合检测AUC为0.862，敏感度为84.39%，特异度为80.17%。脑脊液NSE、SIL-2R、TNF-α单独诊断小儿中枢神经系统感染的AUC分别为0.726、0.804、0.685，敏感度为75.29%、72.81%、79.39%，特异度为73.37%、80.22%、71.29%；联合检测AUC为0.892，敏感度为88.26%，特异度为81.33%。结论:血清及脑脊液NSE、SIL-2R、TNF-α水平对诊断小儿病毒性脑膜炎和细菌性脑膜炎均有一定临床价值，联合检测可显著提高诊断敏感度和特异度，可作小儿病毒性脑膜炎和细菌性脑膜炎的临床诊断参考指标之一。
Diagnostic value of serum and cerebrospinal fluid levels of NSE, SIL-2R, and TNF-α in children with viral meningitis and bacterial meningitis
Objective:To evaluate the diagnostic value of serum and cerebrospinal fluid neuron specific enolase (NSE), soluble interleukin -2 receptor (SIL-2R), and tumor necrosis factor-α (TNF-α) levels in children with viral and bacterial meningitis.Methods:A total of 100 children with central nervous system infection, including 57 cases of viral meningitis and 43 cases of bacterial meningitis treated at Hainan Women and Children's Medical Center from January 2019 to December 2020 were collected. In addition, 42 children who were tested for serum and cerebrospinal fluid during the same period at our hospital and had no central nervous infection were selected as a control group. The levels of NSE, SIL-2R, and TNF-α in serum and cerebrospinal fluid were detected, and the diagnostic efficacy of each index for central nervous system infection in children was assessed by ROC curve analysis.Results:The levels of NSE, SIL-2R and TNF-α in serum and cerebrospinal fluid of children in the viral meningitis group and bacterial meningitis group were significantly higher than those in the control group (P＜0.05). The levels of NSE, SIL-2R and TNF-α in serum and cerebrospinal fluid of children in the bacterial meningitis group were significantly higher than those in the viral meningitis group (P＜0.05). The area under the curve (AUC) values of serum NSE, SIL-2R, and TNF-α each alone for the diagnosis of central nervous system infection in children were 0.707, 0.762, and 0.629, the sensitivities were 73.19%, 71.94%, and 74.35%, and the specificities were 80.92%, 81.35%, and 86.26%, respectively; the AUC, sensitivity, and specificity of the three indexes combined were 0.862, 84.39%, and 80.17%, respectively. The AUC values of cerebrospinal fluid NSE, SIL-2R, and TNF-α each alone for the diagnosis of central nervous system infection in children were 0.726, 0.804, and 0.685, the sensitivities were 75.29%, 72.81%, and 79.39%, and the specificities were 73.37%, 80.22%, and 71.29%, respectively; the AUC, sensitivity, and specificity of the three indexes combined were 0.892, 88.26%, and 81.33%, respectively.Conclusion:The levels of NSE, SIL-2R, and TNF-α in serum and cerebrospinal fluid have appreciated clinical value for the diagnosis of viral meningitis and bacterial meningitis in children. Combined detection of serum or cerebrospinal fluid NSE, SIL-2R, and TNF-α can significantly improve the diagnostic sensitivity and specificity, and can be used as one of the reference indicators for clinical diagnosis of viral meningitis and bacterial meningitis in children.
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