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目的探讨小儿病毒性脑炎和化脓性脑膜炎脑脊液四氢生物蝶呤(BH4)、新蝶呤(NPT)、一氧化氮(NO)水平的变化及其临床意义。方法选择病毒性脑炎患儿30例、化脓性脑膜炎患儿12例、非颅内感染性疾病的患儿20例(对照组),行腰椎穿刺取脑脊液,应用ELISA法测定脑脊液的BH4、NPT和NO水平,并进行比较。结果 3组患儿脑脊液中BH4、NPT和NO水平差异比较均有统计学意义(均P<0.01)。病毒性脑炎组脑脊液中BH4、NPT和NO水平均高于对照组,两组脑脊液中NPT和NO水平差异比较均有统计学意义(P<0.05或0.01),而两组脑脊液中BH4水平比较差异无统计学意义(P>0.05)。化脓性脑膜炎组脑脊液中BH4、NPT和NO水平均高于对照组,两组脑脊液中BH4、NPT和NO水平差异均有统计学意义(均P<0.01);病毒性脑炎组脑脊液中NPT水平高于化脓性脑膜炎组,两组比较差异有统计学意义(P<0.05);而化脓性脑膜炎组脑脊液中BH4和NO水平高于病毒性脑炎组,两组比较差异有统计学意义(P<0.05)。结论脑脊液中NPT和NO水平变化对病毒性脑炎的诊断有辅助作用,脑脊液中BH4、NPT和NO水平变化对化脓性脑膜炎的早期诊断有辅助作用;BH4、NPT和NO水平对这两种疾病的鉴别诊断也有一定的辅助作用。
Objective To investigate the changes of cerebrospinal fluid (CSF) tetrahydrobiopterin (BH4), neopterin (NPT) and nitric oxide (NO) in children with viral encephalitis and purulent meningitis and its clinical significance. Methods Thirty children with viral encephalitis, 12 children with purulent meningitis and 20 children with non-intracranial infection (control group) underwent lumbar puncture. Cerebrospinal fluid (BH4) was measured by ELISA. NPT and NO levels, and compared. Results The levels of BH4, NPT and NO in cerebrospinal fluid in all three groups were significantly different (all P <0.01). The cerebrospinal fluid of patients with viral encephalitis BH4, NPT and NO levels were higher than the control group, the two groups of cerebrospinal fluid in NPT and NO levels were significantly different (P <0.05 or 0.01), while the two groups of cerebrospinal fluid BH4 levels The difference was not statistically significant (P> 0.05). The levels of BH4, NPT and NO in cerebrospinal fluid of patients with purulent meningitis were significantly higher than those of the control group. There were significant differences in the levels of BH4, NPT and NO between the two groups (all P <0.01); cerebrospinal fluid NPT (P <0.05), while the level of BH4 and NO in cerebrospinal fluid of patients with purulent meningitis was higher than that of viral encephalitis group, the differences between the two groups were statistically significant Significance (P <0.05). Conclusions The changes of NPT and NO in cerebrospinal fluid may play an auxiliary role in the diagnosis of viral encephalitis. The changes of cerebrospinal fluid in BH4, NPT and NO may be helpful to the early diagnosis of purulent meningitis. The levels of BH4, NPT and NO in these two The differential diagnosis of the disease also has some supporting role.