| Background and ObjectiveCentral nervous system infectious diseases are common clinical neurological diseases in pediatrics,with high morbidity,mortality and disability rates,which seriously affect the life and health of children.Among them,the common CNS infectious diseases in pediatrics are Bacterial meningitis and Viral encephalitis.It is reported that the fatality rate of BM is 5% to 15%,and the disability rate of BM is15% to 50%.The fatality and disability rates of children in dveloping countries are significantly higher than those in developed countries.It is particularly important to improve the diagnosis and differentiation of intracranial infections,to carry out timely and effective treatment,and to reduce sequelae and disability rates.Intracranial infection is characterized by acute fever,disturbance of consciousness,convulsion,increased intracranial pressure,positive meningeal irritation sign and changes in cerebrospinal fluid,but the molecular mechanism of intracranial infection is not completely clear.Blood-brain barrier is a key factor in maintaining the stability of the central nervous system.It has been found that the destruction of BBB plays an important role in intracranial infectious diseases,and it is also an important cause of brain edema and intracranial hypertension.Fibronectin,vascular endothelial growth factor and lactate dehydrogenase can directly or indirectly affect the stability of BBB,thus affecting the progression of bacterial meningitis and viral encephalitis.Fibronectin(FN)is a high molecular weight glycoprotein in extracellular matrix,which is not only an important part of extracellular matrix,but also participates in the formation of blood-brain barrier basement membrane and maintains the stability of blood-brain barrier.Foreign studies have shown that under the stimulation of hypoxia or inflammatory factors IL-1,the expression of FN is significantly increased.Glycosylation of FN can lead to the damage of blood-brain barrier function and increase its permeability.Vascular endothelial growth factor(VEGF)is a kind of glycoprotein that binds to heparin-containing proteoglycans on the cell surface,which can regulate the growth,permeability and inflammatory response of blood vessels,and can transfer inflammatory cells to the injured site by inducing the destruction of the blood-brain barrier.In the early stage of intracranial infection,after the central nervous system is invaded,the immune reaction and inflammatory reaction can increase the level of VEGF.Lactate dehydrogenase(LDH),as a glycolytic enzyme,widely exists in almost all tissues.When human brain tissue necrosis or blood-brain barrier damage occurs,the lactate dehydrogenase in cerebrospinal fluid will significantly increase.In this study,the levels of FN,VEGF and LDH in cerebrospinal fluid of children with central nervous system infection in different periods were detected,and the correlation analysis was conducted to explore the relationship between FN,VEGF and LDH and the pathogenesis of CNS infection.To clarify the effect of the three on the permeability of the blood-brain barrier provides a new theoretical basis for early clinical identification,diagnosis and treatment of bacterial meningitis and viral encephalitisMethodsResearch object for March 2019-December 2020 in the hospital hospitalized pediatric neurology diagnosis and treatment of 65 cases children of CNS infection of children with bacterial meningitis 31 cases,34 cases of children viral encephalitis,at the same time in 26 cases of hospitalization of the central nervous system infection of children as control group.There was no significant difference in gender,age and other general information between BM,VE and the control group(P > 0.05).Cerebrospinal fluid samples were collected from BM and VE groups during the acute phase(within48h after onset),after treatment(10-14 days after treatment)and within 48 h after onset of the control group.The levels of VEGF,FN and LDH in CSF of the three groups were detected by enzyme-linked immunosorbent assay.Receiver operating characteristic curve was used to analyze the differential diagnostic value of FN,VEGF and LDH for BM and VE,and Pearson coefficient was used to analyze the correlation of the three factors.Results1.The levels of FN,VEGF and LDH in BM group at acute stage were significantly higher than those in control group and VE group(P < 0.05);FN level in VE group was lower than that in control group(P < 0.05).2.The levels of FN,VEGF and LDH in BM group were significantly decreased after treatment(P < 0.05),and the levels of FN and LDH in VE group were significantly decreased after treatment(P < 0.05).The levels of VEGF in VE group were not significantly changed before and after treatment(P > 0.05).3.Differential diagnosis of FN,VEGF and LDH The area under the ROC curve was > 90% in BM group and VE group,BM group and control group,indicating that FN,VEGF and LDH can be used as auxiliary diagnostic indicators for bacterial meningitis and viral encephalitis.4.Correlation analysis was conducted on the levels of FN,VEGF and LDH in cerebrospinal fluid.In the acute phase BM group,there was a positive correlation between FN,VEGF and LDH,and in the acute phase VE group,there was a positive correlation between VEGF and LDH,while there was no correlation among the three indexes in the control group.Conclusions1.The levels of FN,VEGF and LDH in the cerebrospinal fluid of children with bacterial meningitis in the acute stage were significantly higher than those in the control group and the viral encephalitis group,suggesting that the detection of FN,VEGF and LDH levels in the cerebrospinal fluid of children with bacterial meningitis and viral encephalitis in the acute stage has certain clinical auxiliary diagnostic value.2.The correlation analysis of the levels of FN,VEGF and LDH in cerebrospinal fluid suggested that there was some interaction mechanism among the three,which may jointly participate in the molecular mechanism of bacterial meningitis and viral encephalitis. |
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