The Central Nervous System Infections In Patients With Clinical Data Analysis, And The Changes Of Cytokines In Cerebrospinal Fluid And Their Clinical Significance

Central nervous system infections is a common and frequently-occurring disease. The mostcommon infectious diseases are tuberculous meningitis, purulent meningitis and viralmeningoencephalitis. In addition, in recent years, the attack rate of cryptococcalmeningitis is significantly growing. Above all kinds of diseases can be left with highmorbidity and mortality rates. Disease progression, there are strong immune pathologicalreactions caused by immune injury, and to some extent, affect their prognosis. The keys toreduce mortality and morbidity of various diseases are early diagnosis, then select theSpecific treatment programs in accordance with different diseases. It is also necessary forinfection in the immunopathological damage with proper use of glucocorticoids andimmunomodulatory treatment to promote the improvement of disease outcome.Objective：In this experiment, we explore the early clinical features of Central nervoussystem infections in four groups of the central nervous system, which can be judged intime for examination and treatment, through the comparison of tuberculous meningitis,cryptococcal meningitis, purulent meningitis and viral encephalitis in four groups ofpatients with clinical symptoms, signs, cerebrospinal fluid examination and imagingexamination and prognosis characteristics, In addition, we also understand the localimmune pathological state and characteristics of meningeal disease of central nervoussystem infection, through the above dynamic detection of inflammatory cytokines incerebrospinal fluid of the patients with4common central nervous system infections, inorder to find out an effective means for the differential diagnosis of diseases of central nervous system infection, judgment mechanism of immune pathological disease processand application of immune modulation therapy time to make early evaluation ofprognosis.Methods: The experiment firstly use the retrospective survey method, to retrieval theclinical data of449cases for the patients with central nervous system infections (Including89cases of tuberculous meningitis,27cases of purulent meningitis and18cases ofcryptococcal meningitis,315patients with viral encephalitis), including the generalsituation, underlying diseases, clinical manifestations and cerebrospinal fluid examination,imaging, prognosis. Then summarized statistics, establish relevant database, retrospectiveanalysis. The GraphPad Prism5software is used for statistical analysis of the obtaineddata, count data using (%), measurement data is used as（）. At the same time, we usethe Luminex system to detecte the concentration in the cerebrospinal fluid of cytokinesGM-CSF, IFN-γ, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, MCP-1,TNF-α,which is in the76cases of patients with central nervous system infections (27cases of tuberculous meningitis,18patients with cryptococcal meningitis,9cases ofpurulent meningitis,22cases of viral meningitis), and15cases of patients with centralnervous system infections, and then grouped according to their clinical data.The obtaineddata were statistically analyzed using GraphPad5software Prism.Results:1. The two groups of patients with Tuberculous meningitis and cryptococcalmeningitis were mostly complicated with basic chron-ic illness. The basic disease whichcomplicated Tuberculous meningitis are tuberculosis (including lung and other parts) andhepatitis, the clinical symptoms with fever performance of relatively outstanding. Thebasic disease which complicated cryptococcal meningitis patients combined with hepatitis,tuberculosis, autoimmune diseases, HIV infection, lymphoma and the need for a largenumber of long-term application of glucocorticoids or immunosuppressive therapy of thedisease, and the most prominent clinical manifestations is headaches, cerebrospinal fluidpressure increasing obviously, but heat performance is not outstanding.2. It is greatlyclinically significant for the diagnosis of tuberculous meningitis to modify the acid fast stain and the ESAT-6detection in cerebrospinal fluid mononuclear cells. MGG stainingpositive is the gold standard in the diagnosis of cryptococcal meningitis. The diagnosis ofsuppurative meningoencephalitis should as far as possible do blood cultures before in theuse of antibiotics to improve the positive rate of bacteriological examination.3. Overallthe prognosis of the patients with tuberculous meningitis is poor, and treatment of a poorprognosis due to not timely to make early diagnosis, and cryptococcal meningitiscomplicated with basic diseases is an important factor influencing the prognosis ofcryptococcal meningitis. The prognosis of the viral meningitis and purulent meningitis arerelatively ideal. The main cause of viral meningoencephalitis patients death is due to thatit is difficult to maintain vital signs and difficult to control the status epilepticus caused bythe early symptoms of brain injury.4. Comparing with other groups, the levels of IFN-γin tuberculous meningitis increased obviously, while the IL-4level of cerebrospinal fluidin cryptococcal meningitis group was significantly higher than the others.5. IFN-γ andTNF-α in CSF was significantly higher in severe group than that in mild group intuberculous meningitis, cryptococcal meningitis, purulent meningitis group, andconcentrations of IL-8, IL-10in CSF of cryptococcal meningitis and purulentmeningoencephalitis in severe group was significantly higher than that in mild group.6.The levels of GM-CSF, IFN-γ, IL-10, IL-13, TNF-α in cerebrospinal fluid of patientswith tuberculous meningitis were increased in turn in the good prognosis, the poorprognosis and the death group, and the concentration in CSF were decreasing along withthe effective treatment.7.The interaction between many cytokines and immune cells arecomplex, multifaceted, and that can be regulated by many factors. Some cytokines can notonly protect the host in the course of the reaction of central nervous system infection, butalso aggravate the host injury.Conclusion: We should make early comprehensive diagnosis for the patients withcentral nervous system infection combined with medical history, clinical symptoms,examination of cerebrospinal fluid (aspects of cytology, biochemical and pathogen) andHead imaging. Cerebrospinal fluid cytology, the tuberculin antigen detection in theCerebrospinal fluid monocyte with the Content determination of the Cytokine IFN-γ、IL-4 in CSF, will greatly improve the sensitivity for diagnosis of tuberculous meningitis andcryptococcal meningitis. Monitoring the IFN-γ, TNF-α, IL-8and IL-10level in thecerebrospinal fluid has certain value of objective assessment for the judgment of diseaseseverity. The joint detection of GM-CSF, IFN-γ, IL-10, IL-13, TNF-α and multiplecytokines in cerebrospinal fluid has certain significance in a certain extent for thedifferential diagnosis of central nervous system infection disease and prognosis judgment.The dynamic detection of IL-10, TNF-α level dynamic changes in cerebrospinal fluid cannot only provide some objective targets for the interpretation on the treatment effect, butalso provide some guidance value for the treatment’s opportunity of the use ofcorticosteroids and immune regulation.