中国实用神经疾病杂志2025，Vol.28Issue(10)：1189-1194,6.DOI:10.12083/SYSJ.250354
脑脊液/血清APRIL比值变化轨迹的建立对小儿病毒性脑炎病情转归的预测价值
Predictive value of establishment of cerebrospinal fluid/serum APRIL ratio change trajectories in the disease outcome of pediatric viral encephalitis
摘要
Abstract
Objective To investigate the predictive value of establishing the trajectory of changes in the cerebrospinal fluid/serum a proliferation-inducing ligand(APRIL)ratio for the disease outcome of pediatric viral encephalitis(VE).Methods A prospective study was conducted to select 130 pediatric VE from June 2022 to August 2024 in Beijing Friendship Hospital,Capital Medical University as the research subjects.Clinical data of all children were collected,the levels of cerebrospinal fluid and serum APRIL were measured before treatment,and after 3,5 days of treatment,the cerebrospinal fluid/serum APRIL ratio was calculated,and the cerebrospinal fluid/serum APRIL ratio different trajectory groups was screened out using latent class trajectory model(LCTM).Followed-up for 30 days,the disease outcomes of children with VE were statistically analyzed.COX regression analysis was used to investigate the impact of cerebrospinal fluid/serum APRIL ratio trajectory on disease outcomes,and the predictive value of cerebrospinal fluid/serum APRIL ratio trajectory on disease outcomes was analyzed using receiver operating characteristic(ROC)curve analysis.Results The levels of cerebrospinal fluid APRIL,serum APRIL,and the cerebrospinal fluid/serum APRIL ratio in 130 children with VE showed a gradual downward trend before treatment,and after 3 and 5 days of treatment,with statistically significant differences(P＜0.05).The LCTM model was constructed to identify the optimal model when three trajectories were identified,and the change trajectory of cerebrospinal fluid/serum APRIL ratio was divided into three trajectory groups based on the optimal model.Univariate analysis showed that there were significant differences in the incidence of consciousness disorders,abnormal electroencephalogram,number of epileptic seizures,cerebrospinal fluid white blood cell(WBC),C-reactive protein(CRP),interleukin-6(IL-6),and pediatric early warning score(PEWS)among the three trajectory groups(P＜0.05).The incidence of deterioration in the T3 group was 89.66％,which was significantly higher than that in the T2 group(27.27％)and the T1 group(6.52％),with statistically significant differences(P＜0.05).COX regression analysis showed that after adjusting for relevant confounding factors,the risk of deterioration in children with VE in the T2 group and the T3 group increased by 2.654-fold and 5.82-fold compared to group T1,and the linear trend test showed that the risk of deterioration in children with VE in the T1 group,T2 group,and T3 group increased linearly(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of relatively high-high/relatively high trajectory of CSF/serum APRIL ratio for predicting the risk of deterioration in children with VE was 0.859(95％CI:0.787-0.914).Conclusion Cerebrospinal fluid/serum APRIL ratio in pediatric VE has different trajectories of change before and after treatment,and relatively high-high/relatively high trajectory of change indicating a higher risk of VE deterioration and having certain predictive value for disease outcome.It can be used as an effective method for clinical prediction of the disease outcome of pediatric VE and can guide clinical decision-making.关键词
病毒性脑炎/小儿/脑脊液/血清APRIL比值/变化轨迹/病情转归/预测价值Key words
Viral encephalitis/Pediatrics/Cerebrospinal fluid/serum APRIL ratio/Change trajectory/Disease outcome/Prediction valve分类
医药卫生引用本文复制引用
任小忱,王悦,王文慧,李蕾..脑脊液/血清APRIL比值变化轨迹的建立对小儿病毒性脑炎病情转归的预测价值[J].中国实用神经疾病杂志,2025,28(10):1189-1194,6.基金项目
河北省医学科学研究重点课题计划项目(编号:20240471) （编号:20240471）
