CAJ | 학술논문

目的：探讨可溶性髓细胞触发受体-1（soluble form of triggering receptors expressed on myeloid cell-1, sTREM-1）在小儿中枢神经系统感染中的表达及临床意义。方法选择因惊厥、颅压增高等原因收入我院的中枢神经系统感染患儿44例，年龄7 d~3岁。其中细菌性脑膜炎30例，病毒性脑炎14例，无颅内感染19例。入组患儿均于入院后3 h内行腰椎穿刺检查留取脑脊液；细菌性脑膜炎组于痊愈期复查腰穿，留取脑脊液，采用ELISA法测定脑脊液中sTREM-1水平，组间比较行秩和检验。结果细菌性脑膜炎组脑脊液中sTREM-1的水平中位数118.06（四分位间距64.21~233.23 pg/ml），病毒性脑炎组的中位数13.04（四分位间距11.17~16.96 pg/ml），无颅内感染组的中位数10.60（四分位间距9.05~12.34 pg/ml），组间比较差异有统计学意义（P<0.05）。细菌性脑膜炎组中有并发症组的sTREM-1水平中位数为230.45（四分位间距118.06~1086.86 pg/ml），无合并症组的sTREM-1水平中位数为90.25（四分位间距52.03~137.00 pg/ml），差异有统计学意义（P<0.05）。细菌性脑膜炎组急性期脑脊液中sTREM-1水平中位数为106.93（四分位间距55.15~131.64 pg/ml），痊愈期脑脊液中的sTREM-1水平中位数为10.46（四分位间距9.57~12.87 pg/ml），差异有统计学意义（P<0.05）。细菌性脑膜炎组中sTREM-1的水平与脑脊液常规白细胞计数相关系数r=0.52，P=0.000；与蛋白水平相关系数r=0.452，P=0.001；与糖相关系数r=-0.124，P=0.378。血清中的sTREM-1（659.08±389.44）pg/ml，脑脊液中的sTREM-1均值为（489.38±466.70）pg/ml，P=0.04。结论婴幼儿细菌性脑膜炎脑脊液中sTREM-1有着高水平表达，明显高于病毒感染组及无感染组，且随着病情恢复，脑脊液中sTREM-1水平呈下降趋势，疾病的严重程度不同，sTREM-1的表达有明显差异。
목적：탐토가용성수세포촉발수체-1（soluble form of triggering receptors expressed on myeloid cell-1, sTREM-1）재소인중추신경계통감염중적표체급림상의의。방법선택인량궐、로압증고등원인수입아원적중추신경계통감염환인44례，년령7 d~3세。기중세균성뇌막염30례，병독성뇌염14례，무로내감염19례。입조환인균우입원후3 h내행요추천자검사류취뇌척액；세균성뇌막염조우전유기복사요천，류취뇌척액，채용ELISA법측정뇌척액중sTREM-1수평，조간비교행질화검험。결과세균성뇌막염조뇌척액중sTREM-1적수평중위수118.06（사분위간거64.21~233.23 pg/ml），병독성뇌염조적중위수13.04（사분위간거11.17~16.96 pg/ml），무로내감염조적중위수10.60（사분위간거9.05~12.34 pg/ml），조간비교차이유통계학의의（P<0.05）。세균성뇌막염조중유병발증조적sTREM-1수평중위수위230.45（사분위간거118.06~1086.86 pg/ml），무합병증조적sTREM-1수평중위수위90.25（사분위간거52.03~137.00 pg/ml），차이유통계학의의（P<0.05）。세균성뇌막염조급성기뇌척액중sTREM-1수평중위수위106.93（사분위간거55.15~131.64 pg/ml），전유기뇌척액중적sTREM-1수평중위수위10.46（사분위간거9.57~12.87 pg/ml），차이유통계학의의（P<0.05）。세균성뇌막염조중sTREM-1적수평여뇌척액상규백세포계수상관계수r=0.52，P=0.000；여단백수평상관계수r=0.452，P=0.001；여당상관계수r=-0.124，P=0.378。혈청중적sTREM-1（659.08±389.44）pg/ml，뇌척액중적sTREM-1균치위（489.38±466.70）pg/ml，P=0.04。결론영유인세균성뇌막염뇌척액중sTREM-1유착고수평표체，명현고우병독감염조급무감염조，차수착병정회복，뇌척액중sTREM-1수평정하강추세，질병적엄중정도불동，sTREM-1적표체유명현차이。
Objective To detect cerebrospinal fluid levels of soluble triggering receptor expressed on myeloid cells-1(sTREM-1) and to investigate the significance of sTREM-1 in infants with infectious diseases. Methods All subjects were patients hospitalized from January 1, 2011 to December 31, 2011. Patients had persistent convulsion or increased in-tracranial pressure, aged 7d~3y. Sixty-three patients were enrolled. According to the results of cerebrospinal fluid exam, patient were divided into three groups, 30 cases were bacterial meningitis group, 9/30 with complications, 14 cases were viral encephalitis group, 19 cases were patients without central nervous system infection. Cerebrospinal fluid samples were collected from all enrolled patients in 3 hours after they were hospitalized. CSF sTREM-1 was measured by ELISA. The data were analyzed by the rank sum test between groups. Results The level of sTREM-1 in CSF in three groups:the level of sTREM-1 in bacterial meningitis group was 118.06 (median);IQR 64.21-233.23 pg/ml). The level of sTREM-1 in viral encephalitis group was 13.04(median);IQR 11.17-16.96pg/ml. The level of sTREM-1 in Non central nervous system infection group was 0.60 (median);IQR 9.05-12.34 pg/ml). The level of sTREM-1 in bacterial meningitis group was high-er than that of the viral encephalitis group and non central nervous system infection group, the difference was statistically significant. The level of sTREM-1 in viral encephalitis group was higher than non central nervous system infection group, the difference was statistically significant. The levels of sTREM-1 in bacterial meningitis with or without complications, bacterial meningitis with complication was 230.45 (median); IQR 118.06-1086.86 pg/ml, bacterial meningitis without complications was 90.25(median);IQR 52.03-137.00 pg/ml. The level of sTREM-1 in bacterial meningitis with complica-tion group was higher than that without complications. The difference was statistically significant. In acute phase and re-covery phase, the level of sTREM-1 in bacterial meningitis group was different. In acute phase, the level of sTREM-1 was 106.93 (median);IQR 55.15-131.64 pg/ml. In recovery phase, the level of sTREM-1 was 10.46 (median);IQR 9.57-12.87 pg/ml. The level was not different in the acute phase and recovery phase, the difference was statistically significant. The correlation between the sTREM-1 in CSF and leukocyte, protein and glucose in CSF:the correlation coefficient with leu-kocyte was 0.52 P=0.000<0.05. The correlation coefficient of protein was 0.452 P=0.001<0.05, The correlation coeffi-cient with glucose was-0.124, P=0.378>0.05.5. Blood and CSF sample were collected from 10 cases. The mean level of sTREM-1 in serum and CSF in acute phase of bacterial meningitis group was(489.38 ± 466.70)pg/ml,(659.08 ± 389.44) pg/ml in serum. The correlation coefficient was 0.654, P=0.04<0.05, there was significant positive correlation. Conclu?sion The sTREM-1 has high expression level in serum and CSF in infantile bacterial infection. The sTREM-1 is higher in bacterial infection group than that in viral infection group and non infection group. The sTREM-1 decline following the recovery of bacterial infection. There is significant difference according to the infection severity.