TNF-α联合FLAIR序列对新生儿化脓性脑膜炎的诊断价值

摘要

目的 探讨脑脊液肿瘤坏死因子(TNF)-α检测联合磁共振(MRI)增强后液体衰减反转恢复(FLAIR)序列在新生儿化脓性脑膜炎早期诊断中的价值.方法 随机选取2015年4月至2017年1月临沂市妇女儿童医院收治的诊断为化脓性脑膜炎患儿30例作为化脓组,病毒性脑膜炎(VM)患儿30例作为病毒组,比较两组患儿的临床资料,利用Logistic回归分析发病的危险因素,绘制受试者工作曲线(ROC)确定脑脊液TNF-α检测联合磁共振增强后FLAIR序列在新生儿化脓性脑膜炎诊断中的价值.结果 白细胞数、TNF-α、单纯脑水肿、脑水肿合并异常脑电波(EEG)、血沉、FLAIR序列表观弥散系数(ADC)值为化脓性脑膜炎患儿的危险性因素,脑脊液TNF-α检测联合FLAIR序列ADC值对新生儿化脓性脑膜炎的诊断在敏感度(86.72%)、特异度(93.92%)、阳性预测值(96.93%)、阴性预测值(85.64%)、诊断准确率(87.90%)及AUC(0.926)方面均高于单独使用脑脊液TNF-α检测(各项值分别为75.81%、85.32%、82.09%、80.14%、82.33%,0.731)或单独使用FLAIR序列(各项值分别为78.92%、91.25%、80.05%、77.93%、84.46%、0.846)检测的效果.结论 脑脊液TNF-α检测联合增强FLAIR序列扫描用于对新生儿化脓性脑膜炎的早期鉴别诊断,具有更高的检出率,值得在临床中推广使用.%Objective To investigate the value of TNF-α in cerebrospinal fluid combined with MRI enhanced fluid-attenuated inversion recovery(FLAIR)sequence in diagnosis of neonatal purulent meningitis.Methods Thirty neonates with purulent meningitis were randomly selected in pus group and 30 patients with viral meningitis(VM)in virus group from April 2015 to January 2017 in Women and Children's Hospital of Linyi City.Clinical baseline data of two groups were compared and Logistic regression analysis was conducted to analyze the risk factors of disease.ROC was drawn to determine the value of TNF-α in cerebrospinal fluid combined with MRI enhanced FLAIR in diagnosing neonatal purulent meningitis.Results The risk factors of neonatal purulent meningitis included white blood cell count,TNF-α,encephaledema,encephaledema combined with abnormal EEG,erythrocyte sedimentation rate,FLAIR sequential apparent diffusion coefficient(ADC).TNF-α in cerebrospinal fluid combined with FLAIR sequential ADC obtained higher sensitivity(86.72%),specificity(93.92%),positive predictive value (96.93%),negative predictive value(85.64%),diagnostic accuracy(87.90%)and AUC(0.926)than single TNF-α in cerebrospinal fluid examination(75.81%,85.32%,82.09%,80.14%,82.33% and 0.731,respectively)or single FLAIR sequence (78.92%,91.25%,80.05%,77.93%,84.46% and 0.846,respectively).Conclusion TNF-α in cerebrospinal fluid combined with enhanced FLAIR sequence scan has higher detection rate in early diagnosis of neonatal purulent meningitis,and it is worthy of clinical promotion.