摘要
目的探讨血清高迁移率族蛋白⁃1(HMGB⁃1)、中性粒细胞活化肽⁃78(ENA⁃78)和肿瘤坏死因子⁃α(TNF⁃α)在儿童细菌性脑膜炎万古霉素治疗中的动态变化及其临床意义。方法选取2019年1月至2021年12月在山西省儿童医院就诊的儿童细菌性脑膜炎患儿98例作为研究对象,所有患者给予万古霉素治疗,对比患儿治疗前、治疗第3、5、7天后的血清HMGB⁃1、ENA⁃78和TNF⁃α水平变化,依据出院后格拉斯哥预后评分(GOS)分为预后良好组和预后不良组,分析各指标与预后之间的影响因素和预后价值。结果治疗后不同时期血清HMGB⁃1、ENA⁃78和TNF⁃α水平比较:治疗前<治疗1周<治疗2周<治疗3周,差异有统计学意义(F=374.582,346.976,228.307,P<0.05)。预后良好组血清HMGB⁃1、ENA⁃78和TNF⁃α水平均低于预后不良组,差异有统计学意义(t=11.211,12.460,7.266,P<0.05)。多因素分析结果显示,血清HMGB⁃1、ENA⁃78和TNF⁃α水平升高是影响患儿预后的独立影响因素(P<0.05)。ROC曲线分析显示,三者联合预测患儿治疗后预后不良的曲线下面积(AUC)为0.892,均高于单独检测时的AUC、敏感度、特异度(P<0.05)。结论随治疗时间变化,细菌性脑膜炎患儿血清HMGB⁃1、ENA⁃78和TNF⁃α水平逐渐下降,且血清HMGB⁃1、ENA⁃78和TNF⁃α水平联合检测对儿童细菌性脑膜炎万古霉素治疗效果及预后有一定预测价值。
Objective To investigate the dynamic changes and clinical significance of serum high mobility group protein-1(HMGB-1),neutrophil activating peptide-78(ENA-78)and tumor necrosis factor-α(TNF-α)in vancomycin treatment of bacterial meningitis in children. Methods A total of 98 children with bacterial meningitis admitted to Shanxi Children’s Hospital from January 2019 to December 2021 were selected as the research objects,all patients were treated with vancomycin,the changes of serum HMGB-1,ENA-78and TNF-αlevels before treatment,3,5 and 7 days after treatment were tested. According to the Glasgow Outcome Scale(GOS)after discharge,the patients were divided into the good prognosis group and the poor prognosis group,and the influencing factors and prognostic value of each indicator and prognosis were analyzed.Results After treatment,the levels of serum HMGB-1,ENA-78 and TNF-αgradually decreased with the prolongation of treatment time,that is,before treatment <1 week of treatment <2 weeks of treatment <3 weeks of treatment,the differences were statistically significant(P<0.05). The serum levels of HMGB-1,ENA-78and TNF-αin the good prognosis group were lower than those in the poor prognosis group,and the difference was statistically significant(t=11.211,12.460,7.266,P<0.05). The results of multivariate analysis showed that the elevated levels of serum HMGB-1,ENA-78 and TNF-αwere independent factors affecting the prognosis of children(P<0.05). ROC curve analysis showed that the area under the curve(AUC)of the three combined to predict the poor prognosis of children after treatment was 0.892,which were higher than the AUC,sensitivity,and specificity of single detection(P<0.05). Conclusion The serum HMGB-1,ENA-78 and TNF-αlevels in children with bacterial meningitis decreased gradually with the change of treatment time,and the combined detection of serum HMGB-1,ENA-78 and TNF-αlevels has certain predictive value for the treatment effect and prognosis of children with bacterial meningitis with vancomycin.
作者
秦倩倩
张云霞
薛智民
QIN Qianqian;ZHANG Yunxia;XUE Zhimin(Department of Pharmacy,Shanxi Maternal and Child Health Hospital,Taiyuan,Shanxi,China,030013)
出处
《分子诊断与治疗杂志》
2022年第5期870-873,878,共5页
Journal of Molecular Diagnostics and Therapy
基金
山西省儿童医院院内科研基金(201814)。
