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目的 检测小儿急性细菌性脑膜炎患者脑脊液和外周血中肿瘤坏死因子(TNF)-α水平,并探讨其在疾病发生过程中的作用。方法 对28名小儿急性细菌性脑膜炎患者和20 例健康对照儿童,采集外周血清,并行腰椎穿刺收集脑脊液,利用ELISA方法检测外周血和脑脊液中TNF-α水平。经合理选择抗生素治疗,待临床症状控制后,再继续检测外周血和脑脊液中的TNF-α含量。并观察其在疾病发生过程中的作用。结果 我们发现28例小儿急性细菌性脑膜炎患者脑脊液中TNF-α水平明显比健康对照组增高(P< 0.005)。而两组之间外周血中的TNF-α水平比较差异也有显著性(P< 0.01),表现为急性细菌性脑膜炎患者外周血TNF-α显著升高。经过合理选择抗生素治疗后,急性细菌性脑膜炎患者脑脊液中TNF-α浓度比疾病发作时比较明显下降(P< 0.05),并接近健康对照者。结论 TNF-α在小儿急性细菌性脑膜炎脑脊液中明显升高。可能是由于细菌脂蛋白直接刺激诱导淋巴细胞和单核巨噬细胞分泌TNF-α,并参与脑脊膜炎症过程。
Objective To detect the level of tumor necrosis factor-α (TNF-α) in cerebrospinal fluid and peripheral blood of children with acute bacterial meningitis and to explore its role in the pathogenesis of the disease. Methods Peripheral blood was collected from 28 children with acute bacterial meningitis and 20 healthy children. Cerebrospinal fluid (CSF) was collected by lumbar puncture. The levels of TNF-α in peripheral blood and cerebrospinal fluid were detected by ELISA. The rational choice of antibiotics, to be controlled by clinical symptoms, and then continue to test the level of TNF-α in peripheral blood and cerebrospinal fluid. And observe its role in the disease process. Results We found that 28 patients with acute bacterial meningitis in patients with cerebrospinal fluid TNF-α levels were significantly higher than the healthy control group (P <0.005). There was also a significant difference in TNF-α levels in peripheral blood between the two groups (P <0.01), showing a significant increase in peripheral blood TNF-α levels in patients with acute bacterial meningitis. After a reasonable choice of antibiotic treatment, the concentration of TNF-α in cerebrospinal fluid of patients with acute bacterial meningitis was significantly lower than that of the onset of disease (P <0.05), and close to the healthy controls. Conclusion TNF-α in cerebrospinal fluid of children with acute bacterial meningitis was significantly higher. It may be because bacterial lipoprotein directly stimulates the secretion of TNF-α by lymphocytes and monocytes and participates in the process of meningitis.