本文選題：降鈣素原 + C-反應(yīng)蛋白��； 參考：《山東大學(xué)》2012年碩士論文

【摘要】：目的 考察血漿和腦脊液的降鈣素原、C-反應(yīng)蛋白水平在鑒別中樞神經(jīng)系統(tǒng)細(xì)菌感染和病毒感染的價(jià)值。 方法 自2009年11月至2011年10月,收集本院小兒內(nèi)科的中樞神經(jīng)感染的患兒50例,其中27例為病毒性腦炎,男15例,女12例,年齡8.4±4.2月,23例為化膿性腦膜炎,男13例,女10例,年齡7.9±4.8月,另外收集25例同期住院的有神經(jīng)系統(tǒng)癥狀但非感染的患兒作對(duì)照,男15例,女10例,年齡7.7±2.5月。采用酶聯(lián)免疫吸附法(Enzyme Linked Immunosorbent Assay, ELISA)和免疫比濁(Immune Turbidimetry)檢測(cè)法分別檢測(cè)所有患兒治療前后血漿和腦脊液中降鈣素原、C-反應(yīng)蛋白,并對(duì)各組治療前后的指標(biāo)進(jìn)行比較。 結(jié)果 3組患兒的性別、年齡和基礎(chǔ)體溫?zé)o明顯差異,組間具有可比性。25例非感染患兒組在治療前血漿的降鈣素原25例均例低于0.5ng/mL。病毒性腦炎組治療前血漿降鈣素原水平分布：22例0.5ng/mL,3例在0.5ng/mL-2.0ng/mL之間,2例在2.0ng/mL-10.0ng/mL之間；化膿性腦膜炎組治療前血漿降鈣素原水平分布：2例0.5ng/mL,10例在0.5ng/mL-2.0ng/mL之間,7例在2.0ng/mL-10.0ng/mL之間,4例10.0ng/mL。與非感染組患兒比,病毒性腦炎組和化膿性腦膜炎組降鈣素原0.5ng/mL的病例較少(P0.05),與病毒性腦炎組比,化膿性腦膜炎組血漿降鈣素原水平顯著增高(P0.05)。25例非感染組患兒在治療前腦脊液的降鈣素原均低于0.5ng/mL；病毒性腦炎組治療前腦脊液降鈣素原水平分布：24例0.5ng/mL,2例在0.5ng/mL-2.0ng/mL之間,1例在2.0ng/mL-10.0ng/mL之間；化膿性腦膜炎組治療前腦脊液降鈣素原水平分布：16例0.5ng/mL,5例在0.5ng/mL-2.0ng/mL之間,2例在2.0ng/mL-10.0ng/mL之間。與非感染組患兒組比,病毒性腦炎組腦脊液的4個(gè)降鈣素原水平分布病例相似,0.5-10.0ng/mL的病例略高。與病毒性腦炎組比,化膿性腦膜炎組腦脊液降鈣素原0.5ng/mL的病例較低(P0.05),0.5-10.Ong/mL的降鈣素原無(wú)顯著差異(P0.05)。25例非感染組患兒在治療后血漿的降鈣素原均低于0.5ng/mL。病毒性腦炎組治療后血漿鈣素原水平分布：23例0.5ng/mL,3例在0.5ng/mL-2.0ng/mL之間,1例在2.0ng/mL-10.0ng/mL之間；化膿性腦膜炎組治療后血漿降鈣素原水平分布：20例0.5ng/mL,2例在0.5ng/mL-2.Ong/mL之間,1例在2.0ng/mL-10.0ng/mL之間。與非感染組患兒組比,3個(gè)組別治療后血漿降鈣素原無(wú)顯著差異(P0.05)。10例非感染組患兒在治療后腦脊液的降鈣素原均低于0.5ng/mL。病毒性腦炎組治療后腦脊液降鈣素原水平分布：25例0.5ng/mL,2例在0.5ng/mL-2.0ng/mL之間；化膿性腦膜炎組治療后腦脊液降鈣素原水平分布：22例0.5ng/mL,1例在0.5ng/mL-2.0ng/mL之間。3個(gè)組別治療后腦脊液降鈣素原無(wú)顯著差異(P0.05)。25例非感染組患兒血漿C-反應(yīng)蛋白低于2.2mg/L。與非感染組患兒組比,病毒性腦炎組血漿C-反應(yīng)蛋白水平無(wú)顯著差異(2.08±0.12mg/L vs.2.15±0.66mg/L,P0.05),化膿性腦膜炎組血漿C-反應(yīng)蛋白水平顯著增高(2.08±0.12mg/L vs.76.28±24.77mg/L,P0.05)；與病毒性腦炎組比,化膿性腦膜炎血漿C-反應(yīng)蛋白水平明顯增高(2.15±0.66mg/L vs.76.28±24.77mg/L,P0.05)。非感染組患兒腦脊液C-反應(yīng)蛋白水平低于1.3mg/L。與非感染組患兒組比,病毒性腦炎組腦脊液C-反應(yīng)蛋白水平無(wú)顯著差異(1.01±0.13mg/L vs.1.32±1.18mg/L,P0.05),化膿性腦膜炎組腦脊液C-反應(yīng)蛋白水平顯著增高(1.01±0.13mg/L vs.9.48±2.68mg/L,P0.05)；與病毒性腦炎組比,化膿性腦膜炎組腦脊液C-反應(yīng)蛋白水平明顯增高(1.32±1.18mg/L vs.9.48±2.68mg/L,P0.05)。治療后,非感染組患兒血漿C-反應(yīng)蛋白低于2.2mg/L。與非感染組患兒比,病毒性腦炎組的血漿C-反應(yīng)蛋白水平無(wú)顯著變化(2.06±0.21mg/L vs.2.10±0.15mg/L,P0.05),化膿性腦膜炎組血漿C-反應(yīng)蛋白水平仍然較高(2.06±0.21mg/L vs.10.64±2.21mg/L,P0.05)；與病毒性腦炎組比,化膿性腦膜炎組血漿C-反應(yīng)蛋白水平較高(2.06±0.21mg/L vs.10.64±2.21mg/L,P0.05)治療后,非感染組患兒腦脊液C-反應(yīng)蛋白水平低于1.3mg/L。與非感染組患兒比,病毒性腦炎組的腦脊液C-反應(yīng)蛋白水平無(wú)顯著變化(1.10±0.08mg/L vs.1.21±0.20mg/LP0.05),化膿性腦膜炎組腦脊液C-反應(yīng)蛋白水平仍然較高(1.10±0.08mg/L vs.4.26±1.21mg/L,P0.05)；與病毒性腦炎組比,化膿性腦膜炎組腦脊液C-反應(yīng)蛋白水平較高(1.21±0.20mg/L vs.4.26±1.21mg/L,P0.05)與治療前比,非感染組患兒治療后血漿C-反應(yīng)蛋白水平?jīng)]有顯著變化(2.08±0.12mg/L vs.2.06±0.21mg/L,P0.05)與治療前比,病毒性腦炎組患兒治療后血漿C-反應(yīng)蛋白水平?jīng)]有顯著變化(2.15±0.66mg/L vs.2.10±0.15mg/L,P0.05)與治療前比,化膿性腦膜炎組患兒治療后血漿C-反應(yīng)蛋白水平顯著降低(76.28±24.77mg/L vs.10.64±2.21mg/L,P0.05)與治療前比,非感染組患兒治療后腦脊液C-反應(yīng)蛋白水平?jīng)]有顯著變化(1.01±0.13mg/L vs.1.10±0.08mg/L,P0.05),與治療前比,病毒性腦膜炎組患兒治療后腦脊液C-反應(yīng)蛋白水平?jīng)]有顯著變化(1.32±1.18mg/L vs.1.21±0.20mg/L,P0.05)與治療前比,化膿性腦膜炎組患兒治療后腦脊液C-反應(yīng)蛋白水平顯著降低(9.48±2.68mg/L vs.4.26±1.21mg/L,P0.05)。 結(jié)論 聯(lián)合檢測(cè)患者血漿降鈣素原和C-反應(yīng)蛋白,可提高鑒別病毒和細(xì)菌感染的中樞神經(jīng)系統(tǒng)疾病的能力,及時(shí)指導(dǎo)臨床用藥、換藥、減量和停藥,并減少抗生素濫用幾率
[Abstract]:objective
Objective to investigate the value of procalcitonin and C- reactive protein in differential diagnosis of central nervous system bacterial infection and viral infection.
Method
From November 2009 to October 2011, 50 children with central nervous infection in the Department of Pediatrics in our hospital were collected, of which 27 were viral encephalitis, 15 men, 12 women, 8.4 + 4.2 months, 23 cases of suppurative meningitis, 13 males, 10 cases, 7.9 + 4.8 months, and also collected 25 cases of nervous system symptoms but non infected children in the same period of hospitalization. Control, 15 men and 10 women, age 7.7 + 2.5 months. Enzyme Linked Immunosorbent Assay (ELISA) and immunoturbidimetry (Immune Turbidimetry) were used to detect calcitonin and C- reactive protein in the plasma and cerebrospinal fluid (CSF) before and after treatment, and the indexes were compared before and after treatment.
Result
There was no significant difference in sex, age and basal body temperature in the 3 groups. Among the groups, 25 cases of plasma calcitonin before treatment in.25 cases were lower than those of 0.5ng/mL. viral encephalitis before treatment, 22 cases of 0.5ng/mL, 3 cases between 0.5ng/ mL-2.0ng/mL and 2 in 2.0ng/mL-10.0ng/mL. Plasma calcitonin levels were distributed before treatment in the purulent meningitis group: 2 cases of 0.5ng/mL, 10 cases between 0.5ng/mL-2.0ng/mL, 7 cases in 2.0ng/mL-10.0ng/mL, 4 cases of 10.0ng/mL. and non infected children, fewer cases of calcitonin 0.5ng/mL in viral encephalitis and suppurative meningitis group (P0.05), compared with viral encephalitis group, suppurative The levels of calcitonin in the plasma of the meningitis group increased significantly (P0.05) the calcitonin in the cerebrospinal fluid before treatment was lower than that of 0.5ng/mL in.25 non infected children. The distribution of calcitonin in cerebrospinal fluid before treatment in viral encephalitis group: 24 cases of 0.5ng/mL, 2 cases in 0.5ng/mL-2.0ng/mL, 1 cases between 2.0ng/mL-10.0ng/mL; suppurative meningitis. The level distribution of calcitonin in cerebrospinal fluid before treatment: 16 cases of 0.5ng/mL, 5 cases between 0.5ng/mL-2.0ng/mL and 2 cases between 2.0ng/mL-10.0ng/mL. Compared with the non infected group, the 4 cases of calcitonin in the cerebrospinal fluid of viral encephalitis group were similar, and the cases of 0.5-10.0ng/mL were slightly higher. The ratio of the pyogenic meningitis group with the viral encephalitis group, the pyogenic meningitis group was compared with the patients with viral encephalitis. The cases of calcitonin 0.5ng/mL in cerebrospinal fluid (P0.05) were lower (P0.05), and there was no significant difference in calcitonin in 0.5-10.Ong/mL (P0.05) the plasma calcitonin levels were lower in.25 non infected children than in 0.5ng/mL. viral encephalitis group after treatment: 23 cases of 0.5ng/ mL, 3 cases in 0.5ng/mL-2.0ng/mL, and 1 cases in 2.0ng/mL-10.0. Ng/mL; plasma calcitonin levels after treatment with pyogenic meningitis group: 20 cases of 0.5ng/mL, 2 cases in 0.5ng/mL-2.Ong/mL, 1 cases between 2.0ng/mL-10.0ng/mL. Compared with the non infected group, there was no significant difference in plasma calcitonin in 3 groups after treatment (P0.05).10 cases of non infected children after treatment of cerebrospinal fluid calcitonin The distribution of calcitonin levels in cerebrospinal fluid after treatment with 0.5ng/mL. viral encephalitis group: 25 cases of 0.5ng/mL and 2 cases between 0.5ng/mL-2.0ng/mL; the distribution of calcitonin in cerebrospinal fluid after treatment with pyogenic meningitis group: 22 cases of 0.5ng/mL and 1 cases of 0.5ng/mL-2.0ng/mL between.3 groups after treatment (P 0.05) the plasma C- reactive protein in the non infected.25 group was lower than that of the non infected group. The plasma C- reactive protein level of the viral encephalitis group was not significantly different (2.08 + 0.12mg/L vs.2.15 + 0.66mg/L, P0.05), and the level of the plasma C- reactive protein in the suppurative meningitis group was significantly increased (2.08 + 0.12mg/L vs.76.28 24.77mg/L,); The level of C- reactive protein in the plasma of viral encephalitis was significantly higher (2.15 + 0.66mg/L vs.76.28 + 24.77mg/L, P0.05). The level of C- reactive protein in the cerebrospinal fluid of the non infected children was lower than that of the non infected group, and there was no significant difference in the level of C- reactive protein (1.01 + 0.13mg/L vs.1.32 + 1.) in the cerebrospinal fluid of the viral encephalitis group (1.01 + 0.13mg/L vs.1.32 + 1.). 18mg/L, P0.05), the level of C- reactive protein in cerebrospinal fluid of the suppurative meningitis group increased significantly (1.01 + 0.13mg/L vs.9.48 + 2.68mg/L, P0.05), and the level of C- reactive protein in the cerebrospinal fluid of the purulent meningitis group was significantly higher than that in the viral encephalitis group (1.32 + 1.18mg/L vs.9.48 + 2.68mg/L, P0.05). The plasma C- reactive protein level of viral encephalitis group was not significantly changed between 2.2mg/L. and non infected children (2.06 + 0.21mg/L vs.2.10 + 0.15mg/L, P0.05). The plasma C- reactive protein level in the suppurative meningitis group was still higher (2.06 + 0.21mg/L vs.10.64 + 2.21mg/L, P0.05), compared with the viral encephalitis group, the suppurative meningitis group had plasma C- reaction. After the high protein level (2.06 0.21mg/L vs.10.64 + 2.21mg/L, P0.05), the level of C- reactive protein in the cerebrospinal fluid of the non infected children was lower than that of the non infected group. There was no significant change in the level of C- reactive protein (1.10 + 0.08mg/L vs.1.21 + 0.20mg/LP0.05) in the cerebrospinal fluid of the viral encephalitis group (1.10 0.08mg/L vs.1.21 + 0.20mg/LP0.05), and the cerebrospinal fluid in the purulent meningitis group was C-. The protein level was still higher (1.10 + 0.08mg/L vs.4.26 + 1.21mg/L, P0.05). Compared with the viral encephalitis group, the level of C- reactive protein in the cerebrospinal fluid of the purulent meningitis group was higher (1.21 + 0.20mg/L vs.4.26 + 1.21mg/L, P0.05) than before the treatment. There was no significant change in the plasma C- reactive protein level (2.08 + 0.12mg/L vs.2.) in the non infected children after treatment. 06 + 0.21mg/L, P0.05) and before treatment, the level of C- reactive protein in the patients with viral encephalitis was not significantly changed (2.15 + 0.66mg/L vs.2.10 + 0.15mg/L, P0.05), and the level of C- reactive protein in the purulent meningitis group decreased significantly (76.28 + 24.77mg/L vs.10.64 + 2.21mg/L, P0.05) before treatment. There was no significant change in the C- reactive protein level in the cerebrospinal fluid (1.01 + 0.13mg/L vs.1.10 + 0.08mg/L, P0.05) after treatment in the non infected group, and there was no significant change in the level of C- reactive protein in the cerebrospinal fluid of the viral meningitis group (1.32 + 1.18mg/L vs.1.21 + 0.20mg/L, P0.05) and the pyogenic meningitis group. After treatment, the level of C- reactive protein in CSF decreased significantly (9.48 + 2.68mg/L vs.4.26 + 1.21mg/L, P0.05).
conclusion
Combined detection of calcitonin and C- reactive protein in patients can improve the ability to identify viruses and bacterial infections in the central nervous system, timely guide clinical medication, change drugs, reduce and stop drugs, and reduce the risk of antibiotic abuse.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.1

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