Analysis of the relationship between serum NLRP3 inflammasome and neurological function and prognosis in children with viral encephalitis

Han Wei; Yan Xianpeng; Gao Ying; Wang Jieying; Wei Li; Gao Na; Li Ting; Wang Ping

doi:10.3969/j.issn.1671-6450.2025.09.014

Abstract：Objective To investigate the relationship between the serum nucleotide-binding oligomeric domain-like receptor protein 3(NLRP3)inflammasomes and neurological function and prognosis in children with viral encephalitis(VE).Methods A total of 82 children with viral encephalitis diagnosed and treated in Shaanxi Provincial People's Hospital from February 2021 to March 2023 were selected as the study objects,and were divided into mild group(n=31)and severe group(n=51)according to the severity of the disease.The mRNA expression levels of NLRP3,apoptosis-related spot-like protein(ASC),caspase-1(Caspase-1)in peripheral blood mononuclear cells of the 2 groups were compared and the neural function indexes[brain-derived neurotrophic factor(BDNF),central nervous specific protein(S100β),neuron-specific enolase(NSE)]were compared.The correlation between NLRP3 inflammasome index and neural function index was analyzed by Pearson cor-relation analysis.The patients were followed up for 6 months after discharge.GOS score was used to evaluate the prognosis of the children,and they were divided into good prognosis group(n=49)and poor prognosis group(n=33),the clinical/case data of the two groups were compared.Univariate and multivariate Logistic regression analysis of adverse prognostic factors in VE children;ROC curve was drawn to analyze the prognostic value of NLRP3,ASC and caspase-1 mRNA in children.Results The levels of NLRP3,ASC,caspase-1 mRNA,S100β and NSE in severe group were higher than those in mild group.BDNF was lower than that of mild patients(t/P=7.245/＜0.001,6.985/＜0.001,11.319/＜0.001,7.900/＜0.001,3.906/＜0.001,8.452/＜0.001);NLRP3 inflammatory body indexes were positively correlated with S100β and NSE.There was a negative correlation with BDNF(P＜0.01);There were persistent convulsions,moderate and severe EEG abnormalities,severe disease,NLRP3,ASC,caspase-1 Increased mRNA,S100β and NSE levels were independent risk factors for poor prognosis in children with VE,while increased BDNF levels were protective factors for poor prognosis in children with VE[OR(95％CI)=2.057(1.088-3.888),2.002(1.024-3.913),2.026(1.049-3.914),2.489(1.028-6.025),2.428(1.194-4.936),2.261(1.130-4.526),3.442(1.011-11.717),2.641(1.053-6.621),0.325(0.118-0.896)];The AUC of NLRP3,ASC,caspase-1 mRNA and their combi-nation in predicting poor prognosis of VE children were 0.799,0.759,0.818,0.947,respectively.The combined value of the three was better than that of each alone(the difference was compared by DeLong method)(Z=5.266,5.678,4.323,P＜0.001).Conclusion The level of serum NLRP3 inflammatory body index in children with VE is significantly increased,which is closely related to the neurological injury and prognosis of children with VE,and has a good evaluation value for the prognosis of children with VE.