血清bFGF、IFN-γ水平检测对儿童病毒性脑炎的临床诊断价值

The clinical diagnostic value of serum bFGF and IFN-γ levels in children with viral encephalitis

摘要

目的 通过检测病毒性脑炎患儿血清中碱性成纤维细胞生长因子(bFGF)、干扰素γ(IFN-γ)水平,分析bFGF、IFN-γ与病情严重程度的关系及对儿童病毒性脑炎的诊断效能。方法 选取2019年7月至2020年12月邢台市人民医院儿科收治的病毒性脑炎患儿57例作为病毒组,并根据严重程度分为轻型(33例,轻病毒组)、中型(15例,中病毒组)、重型(9例,重病毒组),另取正常体检儿童43例为对照组.通过检测血清bFGF、IFN-γ水平,分析各组中bFGF、IFN-γ水平差异.Pearson相关法分析血清bFGF与IFN-γ水平相关性.受试者工作特征(ROC)曲线分析血清bFGF、IFN-γ对儿童病毒性脑炎的诊断价值。结果 与对照组相比,病毒组血清bFGF、IFN-γ水平均升高,差异有统计学意义(t值分别为5.700、7.234,P<0.05);轻病毒组、中病毒组、重病毒组bFGF、IFN-γ水平依次升高,差异有统计学意义(F值分别为9.554、10.967,P<0.05);Pearson相关法分析显示,病毒组血清bFGF与IFN-γ水平呈正相关性(r=0.528,P<0.001);受试者工作特征(ROC)曲线分析显示,血清bFGF、IFN-γ水平及二者联合诊断病毒性脑炎的曲线下面积(AUC)分别为0.784(95%CI:0.694~0.874)、0.878(95%CI:0.812~0.944)、0.910(95%CI:0.853~0.967);血清bFGF、IFN-γ水平及二者联合检测病毒性脑炎患儿,与临床诊断标准相比Kappa值分别为0.479、0.620、0.609,P<0.05。结论 病毒性脑炎患儿血清bFGF、IFN-γ水平升高,bFGF与IFN-γ呈正相关性,bFGF、IFN-γ联合有助于临床诊断儿童病毒性脑炎.

Abstract

Objective By detecting the levels of basic fibroblast growth factor (bFGF) and interferon-gamma (IFN-γ) in the serum of children with viral encephalitis,this study analyzes the relationship between bFGF,IFN-γ,and the severity of the condition,as well as the diagnostic efficacy of bFGF and IFN-γ for pediatric viral encephalitis. Methods A total of 57 children diagnosed with viral encephalitis and admitted to the Department of Pediatrics,Xingtai People's Hospital,from July 2019 to December 2020 were enrolled as the viral encephalitis group.Based on disease severity,they were further classified into the mild (33 cases,mild viral group),moderate (15 cases,moderate viral group),and severe (9 cases,severe viral group) subgroups.Additionally,43 healthy children undergoing routine physical examinations were included as the control group.Serum bFGF and IFN-γ levels were measured and compared among groups.The correlation between serum bFGF and IFN-γ levels was analyzed using Pearson correlation analysis.The diagnostic value of serum bFGF and IFN-γ for viral encephalitis was evaluated using receiver operating characteristic (ROC) curve analysis. Results Compared with the control group,serum bFGF and IFN-γ levels were significantly elevated in the viral encephalitis group (t=5.700 and 7.234,respectively,P<0.05).Serum bFGF and IFN-γ levels increased progressively from the mild to the moderate and severe viral encephalitis subgroups,with statistically significant differences (F=9.554 and 10.967,respectively,P<0.05).Pearson correlation analysis showed a positive correlation between serum bFGF and IFN-γ levels in the viral encephalitis group (r=0.528,P<0.001).Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for serum bFGF,IFN-γ,and their combined diagnosis of viral encephalitis were 0.784 (95%CI:0.694-0.874),0.878 (95%CI:0.812-0.944),and 0.910 (95%CI:0.853-0.967),respectively.The Kappa values comparing serum bFGF,IFN-γ,and their combined detection with clinical diagnostic standards were 0.479,0.620,and 0.609,respectively (P<0.05). Conclusion Serum bFGF and IFN-γ levels are elevated in children with viral encephalitis,and their levels are positively correlated.The combined detection of bFGF and IFN-γ can aid in the clinical diagnosis of pediatric viral encephalitis.

关键词

病毒性脑炎 / 儿童 / 碱性成纤维细胞生长因子 / 干扰素γ

Key words

viral encephalitis / child / basic fibroblast growth factor / interferon-γ

参考文献

[1] Ren Q, Guo L, Liu X, et al. Analysis of the effect of incentive nursing intervention in children with severe viral encephalitis and myocarditis during rehabilitation based on diffusion weighted MRI[J]. J Healthc Eng, 2021, 2021(1): 1-8.

[2] Costa B K D, Sato D K. Viral encephalitis:a practical review on diagnostic approach and treatment[J]. J Pediatr(Rio J)., 2020, 96(S1): 12-19.

[3] 朱腾文, 郑舒扬, 周云军, 等. 维生素A与免疫功能及儿童感染性疾病的研究[J]. 中国妇幼健康研究, 2020, 31(7): 939-941.

[4] Wu Y, Wang Z, Cai P, et al. Dual delivery of bFGF-and NGF-binding coacervate confers neuroprotection by promoting neuronal proliferation[J]. Cell Physiol Biochem, 2018, 47(3): 948-956.

[5] Chen P, Tang H, Zhang Q, et al. Basic fibroblast growth factor (bFGF) protects the blood-brain barrier by binding of FGFR1 and activating the ERK signaling pathway after intra-abdominal hypertension and traumatic brain injury[J]. Med Sci Monit, 2020, 26: e922009.

[6] Chen G, An N, Ye W, et al. bFGF alleviates diabetes-associated endothelial impairment by downregulating inflammation via S-nitrosylation pathway[J]. Redox Biol, 2021, 41: 101904.

[7] Ramakrishna C, Cantin E M. IFNγ inhibits G-CSF induced neutrophil expansion and invasion of the CNS to prevent viral encephalitis[J]. PLoS Pathog, 2018, 14(1): e1006822.

[8] 王维, 李佳, 王立利, 等. 动态脑电图联合头颅磁共振成像在儿童病毒性脑炎急性期病情及预后评估中应用价值分析[J]. 临床军医杂志, 2019, 47(6): 603-605.

[9] Vova J A, Howarth R A. Evaluation,treatment,and outcomes of viral and autoimmune encephalitis in children[J]. Pediatr Clin North Am, 2023, 70(3): 429-444.

[10] Ai J, Xie Z, Liu G, et al. Etiology and prognosis of acute viral encephalitis and meningitis in Chinese children:a multicentre prospective study[J]. BMC Infect Dis, 2017, 17(1): 494.

[11] Feng G, Zhou L, Li F, et al. Predictors of outcome in clinically diagnosed viral encephalitis patients:a 5-year prospective study[J]. Biomed Res Int, 2020, 2020: 2832418.

[12] Bonney S, Seitz S, Ryan C A, et al. Gamma interferon alters junctional integrity via Rho kinase,resulting in blood-brain barrier leakage in experimental viral encephalitis[J]. mBio, 2019, 10(4): e01675-19.

[13] 彭伟涛, 任玥, 吴晓牧. 固有免疫和适应性免疫在病毒性脑炎发病中的作用机制[J]. 中国神经免疫学和神经病学杂志, 2020, 27(6): 466-469.

[14] 陈鹏, 张清涛, 周玮, 等. 碱性成纤维细胞生长因子降低腹内高压大鼠颅内压的作用[J]. 中华创伤杂志, 2020, 36(5): 455-462.

[15] Tamai M, Kobayashi N, Shimada K, et al. Increased interleukin-1β and basic fibroblast growth factor levels in the cerebrospinal fluid during human herpesvirus-6B (HHV-6B) encephalitis[J]. Biochem Biophys Res Commun, 2017, 486(3): 706-711.

[16] 史晋洁, 王鹰, 苏延倩, 等. 慢性粒细胞白血病患者血清COX-2、bFGF、TGFβ1及VEGF表达水平与疾病严重程度的关系[J]. 临床血液学杂志, 2021, 34(12): 860-863.

[17] 沈开慧, 张孟孝, 周金玲, 等. 病毒性脑炎小儿血清VCAM-1含量检测及与神经损伤、炎症反应的相关关系[J]. 海南医学院学报, 2018, 24(4): 560-562, 566.

[18] 姜之焕, 武怡. 儿童MPP肺泡灌洗液中sB7-H3、IFN-γ的表达水平及临床意义[J]. 徐州医科大学学报, 2020, 40(2): 114-117.

[19] 易继涛, 王从平, 贾敏. IFN-γ、TNF-α、降钙素原和C-反应蛋白水平在细菌性脑膜炎早期诊断中的意义[J]. 神经损伤与功能重建, 2018, 13(3): 122-124.

[20] 孙万里, 鲁增辉, 蔡华锋, 等. 脑脊液ADA、IFN-γ、mir-155、Xpert MTB/RIF水平在结核性脑膜炎诊断中的价值[J]. 河北医药, 2020, 42(16): 2467-2470.

基金资助

河北省卫生和计划生育委员会科研基金项目(20201586)

邢台市重点研发计划自筹项目(2021ZC138)