目的 研究新生儿细菌性脑膜炎(BM)脑脊液(CSF)中激活素A( ACT A)水平的变化及其对预后判断的意义.方法 对2010年3月-2011年6月在本院新生儿病房住院的48例确诊BM患儿,进行3～18个月的随访及回顾性分析,分为有并发症和后遗症组(A组)和无并发症和后遗症组(B组).另收集同期住院的非颅内疾病患儿作为对照组(C组).应用EHSA法动态监测3组患儿CSF中ACT A水平.结果 A组患儿急性期CSF中ACT A水平为(544.39±149.62) ng·L-1,B组CSF中ACT A水平为(480.82±128.24) ng·L-1,二组间差异无统计学意义,但2组均高于C组[(181.06±45.20) ng·L-1](Pa＜0.01).治疗1周,A组CSF中ACT A水平为(315.84±86.35) ng·L-1、B组为(338.25±99.43) ng·L-1,2组较治疗前显著下降(Pa＜0.05),但2组间差异无统计学意义(P=0.432).治疗2周,A组CSF中ACT A水平为(188.19±43.38) ng·L-1,B组为(203.86±50.73) ng·L-1,2组差异无统计学意义(P=0.281).治疗3周,A组CSF中ACT A水平为(107.65±17.65)ng·L-1,B组为( 169.36±28.90)ng·L-1,A组明显低于B组(P =0.000).治疗4周,A组CSF中ACT A水平为(98.54±28.54) ng·L-1,B组为(181.84 ±35.01)ng·L-1,A组显著低于B组(P=0.000).结论 ACT A参与新生儿BM的发病过程,动态检测CSF中ACT A水平,对评估新生儿BM的预后,可能具有重要价值.%Abstract; Objective To evaluate the changes of activin A( ACT A) level in cerebrospinal fluid(CSF) in neonatal bacterial meningitis and its clinical value for prognosis evaluation. Methods Forty - eight neonatal bacterial meningitis in Tianjin Children's Hospital from Mar. 2010 to Jun. 2011 were visited for 3-18 months and analyzed retrospectively. All the patients were divided into 2 groups: neonatal bacterial meningitis with the complications and (or) sequelae group (group A) ,without the complications and sequelae group (group B) ,and the children without brain disease were selected as control group (group C). The levels of ACT A in cerebrospinal fluid of children in 3 groups were monitored by enzyme - linked immunosorbent assay. Results The level of CSF ACT A was (554.39 ± 149- 62) ng · L-1 in the acute phase of group A,and the level of the CSF ACT A was (480. 82 ± 128.24) ng · L-1 in group B,there was no significant difference between the 2 groups. The level of the CSF ACT A in the group A and group B were higher than that in group C[ (181.06 ±45.20) ng · L-1 ] (Pa ＜0.05). Afterl week treatment, ACT A level in CSF was (315.84 ±86.35) ng · L-1 in group A,meanwhile(338.25 ±99.43) ng · L-1 in group B. After 1 week treatment, the level of ACT A in group A and group B had declined than those before treatment (Pa ＜0.05) ,but there was no difference between the 2 groups(P =0.432). After 2 weeks treatment,the same conclusions[ (188. 19 ±43. 38) ng · L-1 and (203- 86 ± 50. 73) ng · L-1]as that of the 1 week treatment had been received. After 3 weeks treatment .the level of ACT A in group A[ ( 107- 65 ± 17. 65 ) ng · L-1 ] was lower than that in group B[ ( 169.36 ± 28.90) ng· L-1(P=0.000 ) ]. After 4 weeks treatment, the same conclusions [(98. 54 ±28.54) ng · L-1 and (211.95 ± 15.53) ng · L-1 ] as that of the 3 weeks treatment had been received( P = 0.000). Conclusions ACT A is involved in the pathogenesis of bacterial meningitis in neonates. The level of ACT A can evaluate the severity and prognosis of bacterial meningitis.
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