| Objective: To study the relationship between the levels of serum and brain Lnterleukin-6 and Lnterleukin-17 in patients with refractory purulent meningitis,and to provide evidence for early diagnosis of refractory purulent meningitis.Methods:(1)From January 2018 to July 2019,children aged from 1 month to 5 years old with purulent meningitis were admitted to the Affiliated Hospital of Youjiang Medical University for Nationalities and Affiliated southwest Hospital of Youjiang Medical University for Nationalities.Among them,55 cases of ordinary purulent meningitis were in the general group,and 40 cases of refractory purulent meningitis were in the refractory group,the control group consisted of 95 healthy children aged from 1 month to 5 years old who came to the health examination center of our hospital at the same time.(2)The clinical data of children were collected,and the White Blood cell count(WBC),Procalcitonin(PCT),C Reactive Protein(CRP),Hypersensitive C Reactive Protein(hs CRP)and the related indexes of cerebral fluid were detected,concurrent culture of pathogenic bacteria from blood and brain crest fluid.The patient underwent Magnetic Resonance Imaging(MRI)and Computed Tomography(CT)examination.The levels of IL-6 and IL-17 in serum of all refractory groups,normal groups and control groups were determined by Enzyme-linked Immunosorbent Assay(ELISA),and the levels of IL-6 and IL-17 in brain crest fluid of both refractory and normal groups were also determined by ELISA.(3)SPSS22.0 software was used for statistical analysis.Results:(1)The incidence of fever,somnolence,vomiting/headache,irritability/rejection of breast milk and convulsion in the refractory group were 77.5%,20.0%,37.5%,17.5%and 42.5%,respectively,and in the general group were 85.5%,21.8%,40.0%,14.5% and36.4%.There was no significant difference in the incidence of fever,somnolence,vomiting/headache,irritability/rejection of breast milk and convulsion between the refractory group and the control group(P>0.05).(2)Compared with the general group,there were significant differences in the levels of WBC,PCT,CRP and HSCRP,the total number of cells,the proportion of neutral cells,adenosine dehydrogenase,protein,and the positive rate of pathogen culture in blood and cerebrospinal fluid in the refractory group(P<0.05),WBC,PCT,CRP and hs CRP,the total number of cells,the proportion of neutral cells,adenosine dehydrogenase,protein and the positive rate of pathogens in blood and cerebrospinal fluid culture were significantly higher in the refractory group than those in the control group.(3)Compared with the general group,there was a significant difference in the imaging changes of the brain in the refractory group(P<0.05),and the imaging changes in the refractory group were significantly higher than those in the general group.Compared with CT group,the detection rate of MRI lesions was significantly higher than that of CT(P<0.05).(4)The levels of IL-6 and IL-17 in the serum of the control group,the general group and the refractory group were significantly different(P<0.05),and the levels of IL-6 and IL-17 in the serum of the refractory group and the refractory group were higher than those in the control group.IL-6and IL-17 levels were significantly different between the two groups(P<0.05).IL-6 and IL-17 levels were significantly different in the two groups.(5)The levels of l L-6 and IL-17 in serum and cerebrospinal fluid were independent variables,with the quantity of cerebrospinal fluid protein and the total number of cells as dependent variables,a regression analysis was applied:Correlation Analysis: there were significant positive correlation between IL-6 serum and protein(r=0.333,P=0.001),IL-6 cerebrospinal fluid and protein(r=0.312,P=0.002),IL-17 serum and protein(r=0.311,P=0.002)(P<0.05).There was no significant correlation between IL-6 serum,IL-6 cerebrospinal fluid,IL-17 serum,IL-17 cerebrospinal fluid and the total number of cells(P>0.05).Regression Analysis: IL-6 serum was used as independent variable and protein quantity was used as dependent variable,IL-6 serum could significantly influence protein quantity,the non-standard regression coefficient was 0.002(P<0.05),IL-6 brain crest fluid was used as independent variable,and IL-6 serum was used as dependent variable,andIL-6 serum was used as Regression analysis,il-6 CSF could significantly influence the protein Regression analysis,the non-standard Regression Coefficient was 0.001(P<0.05),IL-17 serum was the independent variable,the protein quantity was the dependent variable,and IL-17 serum was the Regression analysis,il-17 serum could significantly affect the protein quantification,and the unstandardized regression coefficient was 0.002(P<0.05).Conclusion:(1)The levels of IL-6,IL-17 in serum and IL-6 in cerebrospinal fluid had positive effects on protein quantitation.The higher the levels of IL-6,IL-17 in serum and IL-6in cerebrospinal fluid,the higher the protein quantitation,the more likely the child is to develop refractory purulent meningitis.(2)The levels of IL-6 and IL-17 in serum and brain crest fluid may be useful in the early diagnosis of refractory purulent meningitis.(3)MRI examination has certain guiding value in early diagnosis of refractory purulent meningitis,and the detection rate of MRI focus is higher than that of CT examination.(4)The WBC,PCT,CRP and HSCRP,the total number of cells in the cerebrospinal fluid,the proportion of neutral cells,the positive amount of protein and the positive culture of pathogenic bacteria in the routine laboratory examination have certain reference value for the early diagnosis of refractory purulent meningitis,fever,somnolence,vomiting/headache,irritability/rejection of milk and convulsion were not significant for early diagnosis of refractory purulent meningitis. |
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