降钙素原对开颅术感染患者的致病菌型别的诊断评价

Evaluation of procalcitonin in diagnosing pathogenic types in infected patients after craniotomy

目的探讨降钙素原(PCT)在开颅术后合并颅内感染病原菌种类中的诊断价值及对预后评估的作用。方法回顾性研究医院神经外科2013年10月-2015年10收治的开颅手术患者500例,其中合并颅内感染患者35例,根据合并感染的病原学诊断标准和临床诊断标准分为革兰阴性菌组10例、革兰阳性菌组10例和非细菌性组15例,比较其预后关系,数据采用SPSS 16.0软件进行统计分析。结果不同病原菌引起的开颅术感染的PCT浓度不同,即革兰阴性菌组PCT浓度大于革兰阳性菌组,革兰阳性菌组PCT浓度大于非细菌性组。而C-反应蛋白(CRP)值各组间比较,差异无统计学意义;PCT>5ng/mL患者病死率显著高于PCT<5ng/mL,前者预后差,差异有统计学意义(P<0.01)。结论开颅术后合并感染的病原菌种类与PCT水平有一定相关性,监测PCT水平对临床判断感染病原菌种类有重要应用价值,且对预后评估有指导意义。

OBJECTIVE To evaluate procalcitonin（PCT）in identifying the species of pathogens in post-craniotomy intracranial infection and its effect on prognosis evaluation.METHODS Retrospective analysis was performed on500 cases with post-craniotomy intracranial infections in the neurosurgery department of our hospital from Oct.2013 to Oct.2015.Among them,35 cases were complicated with intracranial infection.Based on the etiological diagnosis and clinical criteria for diagnosis of intracranial infection,these cases were divided into gram-negative bacteria group（n=10）,gram-positive bacteria group（n=10）and non bacteria groups（n=15）,and the correlation between each group of pathogens and PCT level were analyzed by SPSS 16.0.RESULTS The PCT levels of patients with post-craniotomy intracranial infection were various in each groups.PCT level in gram-negative group was higher than that of the gram-positive group,which was higher than non bacterial group.However,CRP values of each group were similar.When PCT〉5ng/mL,patients with bad prognosis had higher fatality rate than those with PCT〈5ng/mL（P〈0.01）.CONCLUSIONThe pathogen species in post-craniotomy intracranial infection has some correlation with PCT levels;monitoring of PCT levels may have clinical value for determining the species of pathogens in post-craniotomy intracranial infection.