脑脊液各项指标联合检测对颅内细菌感染的诊断价值

Diagnostic Value of Joint Detection of Every Index of Cerebrospinal Fluid of the Patients with Intracranial Bacterial Infections

目的通过回顾性分析明确诊断为颅内细菌感染的150例患者的脑脊液检测结果,探讨各项检测指标对颅内细菌感染的诊断价值。方法分别选取临床确诊的150例颅内细菌感染患者的初次脑脊液葡萄糖测定、氯测定、脑脊液总蛋白、脑脊液白细胞计数、脑脊液IgG、脑脊液IgM、脑脊液IgA、细菌培养及结核杆菌荧光定量PCR结果进行统计和分析。结果 (1)感染组与对照组相比,脑脊液白细胞计数和脑脊液总蛋白显著升高,脑脊液氯测定、葡萄糖测定及脑脊液葡萄糖与血液葡萄糖比值显著降低(P<0.01)。(2)感染组与对照组比较,IgG、IgA及IgM均显著升高(P<0.01)。(3)检出前3位分别为凝固酶阴性葡萄球菌、鲍曼不动杆菌和结核杆菌。(4)凝固酶阴性葡萄球菌以耐苯唑西林的葡萄球菌(MRCoSA)为主(77.78%),鲍曼不动杆菌多重耐药性严重。结论脑脊液的生化和常规检查对颅内细菌感染的早期诊断有重要的参考价值,脑脊液特定蛋白测定对颅内细菌感染具有辅助诊断价值,病原学检查有助于颅内细菌感染的确诊。

Objective To discuss the diagnostic value of joint detection of every index of cerebrospinal fluid（CSF） of the patients with intracranial bacterial infections.Methods Joint detection of index of CSF was made to 150 cases with intracranial bacterial infections and the results were statistically analyzed.Results（1） Compared with the control,the leukocyte count and the total protein of CSF of the infected patients increased significantly while the level of chlorine and glucose in CSF dropped down obviously as well as the ratio of CSF glucose and blood glucose（P〈0.01）.（2） The IgG,IgA and IgM of the patients increased significantly（P〈0.01）.（3） The first 3 pathogens were coagulase negative Staphylococci（CNS）,Acinetobacter baumannii and tubercle bacillus.（4） Most of CNS were MRCoSA,and Acinetobacter baumannii was of strong drug-tolerance.Conclusions The biochemical and routine tests of CSF provide references in the early diagnosis of intracranial bacterial infections,the tests of special protein of CSF are helpful to the diagnosis,and pathogenic examinations contribute to the final diagnosis of intracranial bacterial infections.