血清CRP、SAA、PCT联合脑脊液LDH、ADA水平测定在老年中枢神经系统感染中的应用

doi:10.11958/20250729

天津医药 ›› 2025, Vol. 53 ›› Issue (10): 1048-1052.doi: 10.11958/20250729

血清CRP、SAA、PCT联合脑脊液LDH、ADA水平测定在老年中枢神经系统感染中的应用

廖洪柳¹(), 胡艳²^,^△(), 李艳³, 邓才望¹

¹ 达州市中西医结合医院检验科（邮编 365000）
² 成都市第三人民医院检验科
³ 邛崃市第二人民医院检验科

收稿日期:2025-03-01 修回日期:2025-06-19 出版日期:2025-10-15 发布日期:2025-10-12
通讯作者: ^△E-mail：18086806590@163.com
作者简介:廖洪柳（1988），女，主管技师，主要从事基础临床检验方面研究。E-mail：kafc20221230@163.com

The diagnostic value of serum CRP, SAA and PCT combined with LDH and ADA in cerebrospinal fluid in elderly patients with central nervous system infection

LIAO Hongliu¹(), HU Yan²^,^△(), LI Yan³, DENG Caiwang¹

¹ Department of Laboratory Medicine, Dazhou Integrated TCM＆Western Medicine Hospital, Dazhou 365000, China
² Department of Laboratory Medicine, the Third People's Hospital of Chengdu
³ Department of Laboratory Medicine, Qionglai Second People's Hospital

Received:2025-03-01 Revised:2025-06-19 Published:2025-10-15 Online:2025-10-12
Contact: ^△E-mail：18086806590@163.com

廖洪柳, 胡艳, 李艳, 邓才望. 血清CRP、SAA、PCT联合脑脊液LDH、ADA水平测定在老年中枢神经系统感染中的应用[J]. 天津医药, 2025, 53(10): 1048-1052.

LIAO Hongliu, HU Yan, LI Yan, DENG Caiwang. The diagnostic value of serum CRP, SAA and PCT combined with LDH and ADA in cerebrospinal fluid in elderly patients with central nervous system infection[J]. Tianjin Medical Journal, 2025, 53(10): 1048-1052.

摘要/Abstract

摘要：

目的探讨联合检测血清C反应蛋白（CRP）、淀粉样蛋白A（SAA）、降钙素原（PCT）及脑脊液乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）水平在老年中枢神经系统感染中的诊断价值及对感染类型的鉴别意义。方法选取老年中枢神经系统感染患者97例作为感染组，包括结核性脑膜炎31例（结核性脑膜炎组）、化脓性脑膜炎36例（化脓性脑膜炎组）和病毒性脑膜炎30例（病毒性脑膜炎组）。另择同期因原发性头痛就诊且实验室检查指标均正常的97例患者作为对照组。采集患者入院次日清晨空腹肘静脉血，分离血清用于检测CRP、SAA水平；患者就诊时行腰椎穿刺术采集脑脊液用于检测LDH、ADA水平。比较各组间上述指标水平差异，并采用受试者工作特征（ROC）曲线分析各指标及其联合检测对老年中枢神经系统感染的诊断效能。结果感染组患者血清CRP、SAA、PCT及脑脊液LDH、ADA水平均高于对照组（P<0.05）。ROC曲线分析显示，血清CRP、SAA、PCT及脑脊液LDH、ADA单独及联合诊断中枢神经系统感染的曲线下面积均>0.70（P<0.05），预测效能较好，且以联合检测的诊断效能最佳；血清CRP、SAA、PCT及脑脊液LDH、ADA的临界值分别为6.32 mg/L、33.86 mg/L、2.81 μg/L、33.53 U/L、1.99 U/L。血清CRP、SAA、PCT水平在化脓性脑膜炎组最高，病毒性脑膜炎组最低；脑脊液LDH、ADA在结核性脑膜炎组最高，病毒性脑膜炎组最低（P<0.05）。结论联合检测血清CRP、SAA、PCT及脑脊液LDH、ADA水平对老年中枢神经系统感染具有诊断价值，并有助于鉴别感染类型。

关键词: 中枢神经系统感染, 老年人, C反应蛋白质, 血清淀粉样蛋白A, 降钙素原, L-乳酸脱氢酶, 腺苷脱氨酶, 脑脊液

Abstract:

Objective To explore the diagnostic value of serum C-reactive protein (CRP)，serum amyloid A (SAA) and procalcitonin (PCT) combined with lactate dehydrogenase (LDH) and adenosine deaminase (ADA) in cerebrospinal fluid for elderly patients with central nervous system infection and their differential significance for different infection types. Methods A total of 97 elderly patients with central nervous system infection were enrolled as the infection group, including 31 cases with tuberculous meningitis (tuberculous meningitis group)，36 cases with suppurative meningitis (suppurative meningitis group) and 30 cases with viral meningitis (viral meningitis group). A total of 97 patients with normal laboratory examination indexes who were treated due to primary headache during the same period were enrolled as the control group. The samples of fasting elbow venous blood were collected in the early morning of the next day after admission, and the serum was isolated to detect CRP and SAA levels. When consultation, lumbar puncture was performed to collect cerebrospinal fluid for the detection of LDH and ADA levels. The differences in above indexes were compared between groups, and diagnostic efficiency of each index and combined detection for central nervous system infection in elderly was analyzed by receiver operating characteristic (ROC) curves. Results The serum levels of CRP, SAA and PCT, and LDH and ADA in cerebrospinal fluid were higher in the infection group than those in the control group (P<0.05). ROC curve analysis showed that the area under the curve (AUC) values of serum CRP，SAA and PCT, and cerebrospinal fluid LDH and ADA, and combined detection in the diagnosis of central nervous system infection were all >0.70 (P<0.05), showing good predictive efficiency and diagnostic efficiency, and the diagnostic efficacy of combined detection was the best. The cut-off values of serum CRP，SAA and PCT, cerebrospinal fluid LDH and ADA were 6.32 mg/L, 33.86 mg/L, 2.81 μg/L, 33.53 U/L and 1.99 U/L, respectively. The serum levels of CRP, SAA and PCT were the highest in the suppurative meningitis group, while which were the lowest in the viral meningitis group. The cerebrospinal fluid levels of LDH and ADA were the highest in the tuberculous meningitis group, while which were the lowest in the viral meningitis group (P<0.05). Conclusion The combined detection of serum CRP, SAA and cerebrospinal fluid PCT and LDH has certain diagnostic value for elderly central nervous system infection, which is beneficial to identify infection types.

Key words: central nervous system infection, the elderly, C-reactive protein, serum amyloid A protein, procalcitonin, L-lactate dehydrogenase, adenosine deaminase, cerebrospinal fluid

中图分类号:

R742.9

图/表 5

参考文献 20

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组别	n		性别（男/女）		年龄/岁		BMI/（kg/m²）
对照组	97		61/36		70.45±3.82		20.86±2.69
感染组	97		67/30		70.99±3.54		20.79±1.92
χ²或t			0.827		1.103		0.225
组别		高血压史		糖尿病史		冠心病史
对照组		41（42.27）		41（42.27）		43（44.33）
感染组		43（44.33）		40（41.24）		41（42.27）
χ²		0.084		0.021		0.084

组别	n		性别（男/女）		年龄/岁		BMI/（kg/m²）
对照组	97		61/36		70.45±3.82		20.86±2.69
感染组	97		67/30		70.99±3.54		20.79±1.92
χ²或t			0.827		1.103		0.225
组别		高血压史		糖尿病史		冠心病史
对照组		41（42.27）		41（42.27）		43（44.33）
感染组		43（44.33）		40（41.24）		41（42.27）
χ²		0.084		0.021		0.084

组别	血清
组别	CRP/（mg/L）		SAA/（mg/L）		PCT/（μg/L）
对照组	4.63±1.12		6.42±1.88		0.59±0.17
感染组	10.71±3.17		34.86±7.98		4.60±1.35
t	17.828^＊＊		34.161^＊＊		29.124^＊＊
组别		脑脊液
组别		LDH/（U/L）		ADA/（U/L）
对照组		21.76±5.35		0.50±0.12
感染组		43.11±9.72		2.60±0.75
t		18.950^＊＊		27.090^＊＊

组别	血清
组别	CRP/（mg/L）		SAA/（mg/L）		PCT/（μg/L）
对照组	4.63±1.12		6.42±1.88		0.59±0.17
感染组	10.71±3.17		34.86±7.98		4.60±1.35
t	17.828^＊＊		34.161^＊＊		29.124^＊＊
组别		脑脊液
组别		LDH/（U/L）		ADA/（U/L）
对照组		21.76±5.35		0.50±0.12
感染组		43.11±9.72		2.60±0.75
t		18.950^＊＊		27.090^＊＊

指标	AUC	95%CI	截断值	敏感度/ %	特异度/ %	约登指数
血清CRP	0.759	0.693~0.818	6.32 mg/L	67.00	78.40	0.454
血清SAA	0.751	0.684~0.810	33.86 mg/L	63.90	78.40	0.423
血清PCT	0.785	0.721~0.841	2.81 μg/L	66.00	86.60	0.526
脑脊液LDH	0.722	0.653~0.784	33.53 U/L	56.70	93.80	0.505
脑脊液ADA	0.799	0.736~0.853	1.99 U/L	73.20	94.80	0.680
联合检测	0.954	0.915~0.979	-	83.50	78.40	0.793

血清CRP、SAA、PCT联合脑脊液LDH、ADA水平测定在老年中枢神经系统感染中的应用

The diagnostic value of serum CRP, SAA and PCT combined with LDH and ADA in cerebrospinal fluid in elderly patients with central nervous system infection

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组别	n	血清
组别	n	CRP/（mg/L）		SAA/（mg/L）		PCT/（μg/L）
结核性脑膜炎组	31	9.90±1.69		32.02±2.92		4.59±0.99
化脓性脑膜炎组	36	13.64±2.84^a		43.83±4.11^a		5.64±1.11^a
病毒性脑膜炎组	30	8.02±1.26^ab		27.04±3.15^ab		3.36±0.74^ab
F		62.210^＊＊		206.642^＊＊		45.171^＊＊
组别			脑脊液
组别			LDH/（U/L）		ADA/（U/L）
结核性脑膜炎组			53.13±5.23		3.11±0.65
化脓性脑膜炎组			44.60±3.44^a		2.82±0.47^a
病毒性脑膜炎组			30.97±2.75^ab		1.80±0.42^ab
F			246.703^＊＊		53.075^＊＊

组别	n	血清
组别	n	CRP/（mg/L）		SAA/（mg/L）		PCT/（μg/L）
结核性脑膜炎组	31	9.90±1.69		32.02±2.92		4.59±0.99
化脓性脑膜炎组	36	13.64±2.84^a		43.83±4.11^a		5.64±1.11^a
病毒性脑膜炎组	30	8.02±1.26^ab		27.04±3.15^ab		3.36±0.74^ab
F		62.210^＊＊		206.642^＊＊		45.171^＊＊
组别			脑脊液
组别			LDH/（U/L）		ADA/（U/L）
结核性脑膜炎组			53.13±5.23		3.11±0.65
化脓性脑膜炎组			44.60±3.44^a		2.82±0.47^a
病毒性脑膜炎组			30.97±2.75^ab		1.80±0.42^ab
F			246.703^＊＊		53.075^＊＊