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Liu et al. Low antioxidant status of patients with CNSI

INTRODUCTION patients with CNSI who were hospitalized in the
Third Affiliated Hospital of Sun Yat-sen University
The pathogenesis of central nervous system infections from January 2008 to June 2015. A total of 434
(CNSI) has not yet been completely understood, CNSI patients satisfying the diagnostic criteria were
but some scholars have indicated that oxidative recruited in our study. Another 114 healthy subjects
stress and antioxidant imbalance may induce brain came to our hospital for check-ups at the same
injury. Reactive oxygen species (ROS) and reactive period and served as control patients. CNSI patients
nitrogen species (RNS) may play a vital role in certain were divided into 5 groups: viral meningitis and/or
pathological processes acting as inflammatory agents meningoencephalitis (VM), cryptococcus meningitis
causing intracranial complications. [1,2] ROS, such and/or meningo-encephalitis (CM), tuberculous
as superoxide anion, hydrogen peroxide or hydroxyl meningitis and/or meningoencephalitis (TM), bacterial
radicals, may result in damage to cellular DNA, proteins meningitis and/or meningoencephalitis (BM),
and lipids, and even causing cell death. RNS, such cysticercosis of brain (BC) [Figure 1]. For the diagnosis
[3]
as peroxynitrite (ONOO-), is a strong oxidant that can of meningitis and Neurocysticercosis, we took into
be cytotoxic including nitrotyrosine or lipidperoxidation account the patient history, symptomatology, along
in bacterial meningitis. Oxidative stress, which plays with regional epidemiology, and basic cerebrospinal
[4]
a major role in disease pathogenesis, is defined as fluid testing. [15,16]
an imbalance in ROS and antioxidants. Cells use
enzymatic and non-enzymatic antioxidants to control Demographic and clinical features of patients with
ROS levels to maintain an appropriate cellular redox CNSI and healthy controls (HC) are shown in Tables
balance. If antioxidant capacity is exhausted, an 1 and 2.
imbalance between oxidant and antioxidant status will
lead to a state of oxidative stress, which could change Venous blood samples were drawn in the morning
the susceptibility of membranes and inactive biological after patients’ admission. Total serum UA, albumin and
molecules to damage. [5-7] Therefore, enhanced bilirubin concentrations were measured using a Clinical
antioxidant protection and restored native homeostasis Analyzer 7180-ISE (Hitachi High-Technologies, Tokyo,
may be beneficial to the treatment of CNSI. Japan). Serum UA concentrations were measured
using a UA assay kit based on the direct enzymatic
Uric acid (UA), as a scavenger of peroxynitrite, could oxidation of uric acid. Serum bilirubin concentrations
inhibit central nervous system (CNS) inflammation and were also measured by an enzymatic method with
change blood-CNS barrier permeability, is considered bilirubin oxidase.
to have a neuroprotective role. [8-10] Endogenous
bilirubin converted from biliverdin, is an end product The following subjects were excluded (1) patients
of heme degradation by biliverdinreductase (BVR).
[11]
Some studies confirmed that bilirubin could effectively
block seizure-induced ROS and play a role in
cerebroprotective effects. Albumin, accounting for
[12]
about 70% of the plasma colloid osmotic pressure, plays
a vital role in maintaining the normal fluid distribution
and constitutes the main circulating antioxidant system
in the body. As potent scavengers of ROS derived
from oxidative stress, albumin is the major source of
extracellular reduced sulfhydryl groups (-SH). [13]

That is to say, UA, total bilirubin (Tbil) and albumin,
are the major nonenzymatic antioxidant components
of serum. However, the situation of antioxidant
[14]
status in different patterns of CNSI has not fully been
investigated. Therefore, we retrospectively evaluated
the antioxidant status of serum UA, bilirubin and
albumin in patients with CNSI. Figure 1: Enrollment process of patients. CNSI: central
nervous system infections; VM: viral meningitis and/or
METHODS meningoencephalitis; BC: cysticercosis of brain; TM: tuberculous
meningitis and/or meningoencephalitis; CM: cryptococcus
meningitis and/or meningoencephalitis; BM: bacterial meningitis
We retrospectively reviewed the clinical data of 598 and/or meningoencephalitis; HIV: human immunodeficiency virus
Neuroimmunology and Neuroinflammation ¦ Volume 3 ¦ December 15, 2016 263