Clinical Significance Of CSF Inflammatory Factor Level And CD18~+ Leukocyte Number In Children With Intracranial Infection

Objective Purulent meningitis(PM)and viral encephalitis(VE)are the most common types of intracranial infection in infants and young children.Pathogenic microorganisms invade the central nervous system(CNS),leading to different degrees of brain tissue injury,if not treated in time,Seriously ill children can cause permanent central nervous system sequelae.Cerebrospinal fluid(CSF)in the detection of various routine and biochemical indicators is an important means of diagnosis and differential diagnosis of intracranial infection.In this study,we explored CSF inflammatory factors interleukin-6(IL-6),interleukin-8(IL-8),C-reactive protein(CRP)in infants with intracranial infection.The expression level and the law of changes in the CD18~+leukocytes provide the basis for the diagnosis and differential diagnosis of intracranial infections in infants and children,and the evaluation of therapeutic effects.Methods From January 2017 to December 2018,50 infants with purulent meningitis(group ?)and 50 infants with viral encephalitis(group ?)were enrolled in the neonatal department of Linyi people's hospital.Indications of lumbar puncture at hospital admission were selected,and patients with intracranial infection were excluded as normal control group.40 cases were group?.There were 29 boys and 21 girls in group ? with an average age of(7.08±2.40)months;26 boys and 24 girls in group ? with an average age of(6.61±2.54)months;40 controls in group ? with 18 boys and 22 girls with an average age of(6.76±2.56)months.The criteria of all cases were in accordance with the diagnostic criteria for intracranial infection in the 8th edition of Pediatrics.CSF samples were collected from group ? and group ? in the acute stage within 3 days after the onset of the disease and in the recovery stage one week after the treatment.The CD18~+leukocytes was detected by Flow Cytometry,IL-6 and IL-8 were detected by ELISA,and CRP was detected by immunoturbidimetry.SPSS 22.0 software was used for statistical analysis.The metering data is represented by(mean±standard deviation).The cross table chi square test was used to compare the differences in gender composition of multiple groups,the single factor ANOVA was used to compare the mean of multiple groups,the LSD-t test was used to compare the two groups,and the multiple linear regression analysis was carried out to analyze the correlation,the ROC curve analysis was used to evaluate the diagnostic efficacy.The difference between groups was statistically significant with P<0.05.Results(1)In acute stage,the levels of IL-6,IL-8,CRP and CD18~+leukocytes in group ? were significantly higher than those in group ? and group ?(P<0.01).Compared with group ?,the difference of IL-6 and IL-8 in group ? was statistically significant(P<0.01),the difference of CD18~+leukocyte was statistically significant(P<0.05),and the difference of CRP level was not statistically significant(P>0.05);(2)During the recovery period,the levels of IL-6,IL-8,CRP and CD18~+leukocyte in group ? were significantly higher than those in group ? and group ?,and the difference was statistically significant(P<0.01).Compared with group ?,the level of IL-8 in group ? was statistically significant(P<0.05),while the level of IL-6,CRP and CD18~+leukocytes were not significantly different(P>0.05);(3)Compared with the recovery period,the levels of IL-6,IL-8,CRP and CD18~+leukocytes in group ? were significantly higher in the acute period than in the recovery period(P<0.01,P<0.01,P<0.01,P<0.01);the levels of IL-6,IL-8,CRP and CD18~+leukocytes in group ? were significantly higher in the acute period than in the recovery period(P<0.01,P<0.01,P<0.05,P<0.01);(4)In the acute period In group ?,CD18~+leukocytes were positively correlated with IL-6 and IL-8(r=0.622,P=0.000),but not with CRP,IL-8 and age(P>0.05),in group ?,CD18~+leukocytes were positively correlated with IL-8(r=0.589,P=0.002),but not with IL-6,CRP and age(P>0.05);in the recovery period,there was no correlation between CD18~+leukocytes and IL-6,IL-8,CRP,age in group ?(P>0.05),there was a positive correlation between CD18~+leukocytes and IL-8 in group ?(r=0.519,P=0.001),but no correlation between CD18~+leukocytes and age,IL-6,CRP(P>0.05);(5)For group?patients,the area under the ROC curve CD18~+leukocytes>IL-8>CRP>IL-6{0.882,0.879,0.871,0.859;95%CI(0.828,0.936),95%CI(0.823,0.936),95%CI(0.813,0.929),95%CI(0.796,0.921)};for group ? patients,area under the ROC curve IL-8>IL-6>CD18~+leukocytes>CRP{0.846,0.792,0.584,0.578;95%CI(0.779,0.913),95%CI(0.713,0.871),95%CI(0.483,0.685),95%CI(0.480,0.676)};(6)When the CD18~+leukocytes,IL-6,IL-8 and CRP are combined and analyzed,the area under the ROC curve is 0.930,95%CI(0.890,0.969),which has the highest diagnostic efficacy for purulent meningitis;in the combined analysis of IL-6 and IL-8,the area under the ROC curve is 0.846,95%CI(0.779,0.913),which has the highest diagnostic efficacy for viral encephalitis.Conclusion(1)Detection of CD18~+leukocytes,IL-6,IL-8 and CRP levels in CSF can be used for diagnosis and differential diagnosis of meningitis and viral encephalitis.(2)Detection of CD18~+leukocytes,IL-6,IL-8 and CRP levels in CSF can be used to evaluate the efficacy of purulent meningitis and viral encephalitis.(3)The combined detection of CD18~+leukocytes,IL-6,IL-8 and CRP in CSF is more valuable for the diagnosis of purulent meningitis,and the combined detection of IL-6 and IL-8 is more helpful for the diagnosis of viral encephalitis.