血清PTX3和NLRP3联合检测在颅脑损伤术后颅内感染早期诊治中的应用研究

Application of serum PTX3 and NLRP3 in the early diagnosis and treatment of intracranial infection after craniocerebral injury surgery

目的研究血清正五聚体蛋白3(PTX3)、寡聚化结构域样受体蛋白3(NLRP3)联合检测在颅脑损伤术后颅内感染早期诊治中的应用。方法2018年4月-2020年10月于海南西部中心医院及上海交通大学医学院附属第九人民医院就诊的72例于术后发生颅内感染的颅脑损伤患者,作为感染组;另选择同期接受治疗且未发生术后颅内感染的80例颅脑损伤患者,作为未感染组。比较感染组与未感染组患者术后早期血清PTX3、NLRP3的表达水平,通过绘制受试者工作特征(ROC)曲线分析血清PTX3、NLRP3因子及联合检测对术后颅内感染发生的诊断价值,根据严重程度将感染组患者分为轻度感染组(n=35)、中度感染组(n=22)、重度感染组(n=15),根据术后颅内感染类型将感染组患者分为单一感染组(n=43)和混合感染组(n=29),根据颅内感染的预后控制情况将感染组患者分为控制有效组(n=51)和控制无效组(n=21),比较不同亚组患者血清PTX3、NLRP3的表达水平。结果感染组患者术后1 d血清PTX3、NLRP3水平均高于未感染组,差异有统计学意义(P<0.05);PTX3、NLRP3及联合诊断颅内感染的曲线下面积(AUC)分别为0.794、0.698、0.837,联合诊断价值高于单一指标诊断价值,差异有统计学意义(P<0.05)。重度感染组术后1 d血清PTX3、NLRP3水平高于中度感染组、轻度感染组,中度感染组术后1 d血清PTX3、NLRP3水平高于轻度感染组,差异有统计学意义(P<0.05)。单一感染组血清PTX3、NLRP3水平低于混合感染组,差异有统计学意义(P<0.05);控制有效组血清PTX3、NLRP3水平低于控制无效组,差异有统计学意义(P<0.05)。结论血清PTX3、NLRP3联合检测较单一指标对颅脑损伤术后颅内感染的诊断效能更高,颅脑损伤患者术后早期血清PTX3、NLRP3水平与颅内感染程度、感染类型及预后情况相关。

Objective To study the application of serum pentraxin 3(PTX3)combined with nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in the early diagnosis and treatment of intracranial infection after craniocerebral injury surgery.Methods A total of 72 patients with intracranial infection after craniocerebral injury surgery treated in Hainan West Central Hospital and the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from April 2018 to October 2020 were enrolled as infection group,while another 80 craniocerebral injury patients without intracranial infection were enrolled as non-infection group.The expression levels of serum PTX3 and NLRP3 were compared between the two groups.The diagnostic value of serum PTX3,NLRP3 and their combination for postoperative intracranial infection was analyzed by receiver operator characteristic(ROC)curves.According to infection severity,patients in infection group were divided into mild infection group(n=35),moderate infection group(n=22)and severe infection group(n=15).According to different types of intracranial infection,patients in infection group were divided into single infection group(n=43)and mixed infection group(n=29).According to different prognosis of intracranial infection,patients in infection group were divided into effective control group(n=51)and ineffective control group(n=21).The expression levels of serum PTX3 and NLRP3 in different subgroups were compared.Results The levels of serum PTX3and NLRP3 at 1 d after surgery in infection group were higher than those in non-infection group(P<0.05).The area under curve(AUC)values of PTX3,NLRP3 and their combination for diagnosis of intracranial infection were0.794,0.698 and 0.837,respectively.The diagnosis value of their combination was higher than that of single index(P<0.05).The levels of serum PTX3 and NLRP3 in severe infection group were higher than those in moderate infection group and mild infection group on day 1 after surgery,and the levels of serum PTX3 and NLRP3 in moderate infection group were higher than those in mild infection group on day 1 after surgery,the difference was statistically significant(P<0.05).The levels of serum PTX3 and NLRP3 in single infection group were lower than those in mixed infection group(P<0.05),which were lower in effective control group than ineffective control group(P<0.05).Conclusions The diagnostic efficiency of serum PTX3 combined with NLRP3 was higher than that of single index for intracranial infection after craniocerebral injury surgery.The levels of early serum PTX3 and NLRP3 were related to severity of intracranial infection,infection type and prognosis in patients with craniocerebral injury.