| Background & ObjectiveCentral nervous system infection is one of the common nervous system diseases. In recent years, this disease is a trend of increase. The early diagnosis for central nervous system infection patients is the key of saveing lives and reducing the sequela. Many cases in clinical tend to present with atypical symptoms and laboratory test results because of plenty of antibiotics is being used and complex clinical manifestations of meningitis, which leads to delays in clinical diagnosis and treatment; CSF cytology tests in the central nervous system infection are most nonspecific, and the detection of pathogen is difficult, resulting in difficulty in diagnosis and high rate of misdiagnosis and missed diagnosis rate.Mycobacterium tuberculosis is already found one of the most important infectious agents among them, accurate diagnosis and early treatment are decisive factors in the prognosis of tuberculous meningitis.Genome analysis shows that the genome of M. Tuberculosis includes more than 4000 genes,Of which 250 genes encoding enzymes related to fatty acid metabolism.The cell wall of Mycobacterium tuberculosis is based on a conventional peptidoglycan, which covalently linked to an arabinogalactan esterified with mycolic acids. Mycolic acids are the largest fatty acids in nature, which are closely related to the virulence of Mycobacterium tuberculosis and the ability to escape immune system attacks. All the evidences show the importance of fat metabolism of Mycobacterium tuberculosis.DLL1 (Delta-Like 1) is a human homolog of the Drosophila Notch ligand Delta.DLL1 is the 723-amino acid type 1 transmembrane protein,having a DSL domain followed by 8 tandem EGF-like repeats and a short cytoplasmic C-terminal region.A cDNA encoding DLL1 was isolated by a PCR cloning approach utilizing a primer pair whose sequences were derived from the Delta gene.Notch,as a transmembrane receptor, plays important roles in the development of many organs and cells, mainly direct the cell differentiation. Thus, the inhibition, gene mutation or abnormal activati of Notch signaling pathway may be related to many neurological diseases such as Alzheimer's disease, Parkinson's disease, stroke, brain tumors, reperfusion injury and so on. Moreover, Notch1 signaling can influence the formation of fat cells by regulating the transcription factor activated by fatty acid, which plays an important rolein fat metabolism. Based on the above theoretical we speculate that Tuberculosis is a chronic wasting disease, leading to fat metabolism disorders and fat cell overdifferentiation.As the Notch ligands,the accelerated shedding of DLL1 can help Notch signaling promote the differentiation of fat cells.Therefore, in this study, to explore clinical value of levels of soluble DLL1 of the Notch Delta ligand in diagnosis of central nervous system infection, in order to quest a new diagnostic method of tuberculous meningitis, ELISA quantitative determination was used to determine the DLL1 content in CSF and serum of patients with the central nervous system infections.Materials and MethodologyThe 90 diagnosis explicit central nervous system infects patients were divided into three groups, group TM included 40 tuberculous meningitis sick patients, groupVM included 30 viral meningitis cases, group PM included 20 purulent meningitis cases, group IMT included 12 Intracranial Metastatic Tumors cases, group MS included 9 multiple sclerosis cases, group GBS included 7 Guillain-Barre syndrome cases, compared with 28 control cases of no central nervous system infection. Soluble DLL1 in CSF and serum of these patients were synchronal detected by using ELISA.Results1. The levels of CSF soluble DLL1 in TM were obviously higher than those of VM and PM and control group and IMT and MS and GBS (3.75±3.28, VS 0.14±0.15,0.20±0.18,0.13±0.13,0.29±0.35,0.15±0.16,0.11±0.14, P< 0.01), there were no significant differences among VM and PM and IMT and MS and GBS and control cases (P>0.05).2. The levels of serum soluble DLL1 in TM and IMT were obviously higher than those of VM and PM and control group and MS and GBS (P<0.01), there were no significant differences among VM and PM and MS and GBS and control cases (P>0.05). there were no significant differences between TM and IMT cases (P>0.05).3. The levels of CSF soluble DLL1 was not relevant with CSF protein and CSF cell count and CSF glucose and CSF chloride and intracranial pressure in all groups.Conclusion1. The levels of soluble DLL1 in TM CSF and serum had vary obviously increased in disease with central nervous system infection, but there were low in among VM and PM and control and MS and GBS cases, it was also low in IMT CSF.2. These soluble DLL1 by measuring together in CSF and serum had an important value to diagnosis and differential diagnosis of three kinds of central nervous system infection, can become a new valuable diagnostic material in disease with central nervous system infection, moreover method simpleness.3. Measurement of soluble DLL1 as a novel indication, in the tubercular meningitis diagnose possibly have the potential important clinical value. |
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