小儿病毒性脑炎和化脓性脑膜炎脑脊液四氢生物蝶呤、新蝶呤、一氧化氮水平的变化及临床意义

摘要

目的：探讨小儿病毒性脑炎和化脓性脑膜炎脑脊液四氢生物蝶呤（BH4）、新蝶呤（NPT）、一氧化氮（NO）水平的变化及其临床意义。方法选择病毒性脑炎患儿30例、化脓性脑膜炎患儿12例、非颅内感染性疾病的患儿20例（对照组），行腰椎穿刺取脑脊液，应用ELISA法测定脑脊液的BH4、NPT和NO水平，并进行比较。结果3组患儿脑脊液中BH4、NPT和NO水平差异比较均有统计学意义（均P＜0.01）。病毒性脑炎组脑脊液中BH4、NPT和NO水平均高于对照组，两组脑脊液中NPT和NO水平差异比较均有统计学意义（P＜0.05或0.01），而两组脑脊液中BH4水平比较差异无统计学意义（P＞0.05）。化脓性脑膜炎组脑脊液中BH4、NPT和NO水平均高于对照组，两组脑脊液中BH4、NPT和NO水平差异均有统计学意义（均P＜0.01）；病毒性脑炎组脑脊液中NPT水平高于化脓性脑膜炎组，两组比较差异有统计学意义（P＜0.05）；而化脓性脑膜炎组脑脊液中BH4和NO水平高于病毒性脑炎组，两组比较差异有统计学意义（P＜0.05）。结论脑脊液中NPT和NO水平变化对病毒性脑炎的诊断有辅助作用，脑脊液中BH4、NPT和NO水平变化对化脓性脑膜炎的早期诊断有辅助作用；BH4、NPT和NO水平对这两种疾病的鉴别诊断也有一定的辅助作用。%Objective To investigate the levels of tetrahydrobiopterin(BH4), neopterin (NPT) and nitric oxide (NO) levels in cerebrospinal fluid (CSF) in children with viral encephalitis or purulent meningitis. Methods Thirty children with viral encephalitis, 12 children with purulent meningitis and 20 children with peripheral infection (control group) were enrol ed in the study. CSF samples were col ected by lumbar puncture in three groups at admission. The concentrations of BH4, NPT and NO in CSF were detected by enzyme linked immunosorbent assay (ELISA). Results There were significant differences in CSF levels of BH4, NPT and NO among three groups (F=5.726, 29.317 and 8.064, P<0.01). The CSF concentrations of NPT and NO in children with viral encephalitis had were higher than those in control group (P<0.01, P<0.05). The CSF concentrations of BH4, NPT and NO in children with purulent meningitis were higher than those in the control group (P<0.01). The concentration of NPT in CSF of the viral encephalitis group was higher than that of purulent meningitis group (P<0.05). The concentrations of BH4 and NO in CSF of purulent meningitis group were higher than those of viral encephalitis group(P<0.05). Conclusion The detection of BH4, NPT, NO in CSF may be of value in differential diagnosis between viral encephalitis and purulent meningitis in children.