血清降钙素原和脑脊液降钙素原检测在成年人中枢神经系统细菌感染中的应用

Application of serum and CSF procalcitonin detection in adult patients with CNS bacterial infection

目的分析血清和脑脊液降钙素原水平检测在成年人中枢神经系统感染诊断中的临床价值,为成年中枢神经系统感染患者的临床诊断和治疗提供参考。方法选取该院2015年2月至2015年12月收治的成年中枢神经性系统疾病患者60例作为研究对象。所有患者初诊疑似有中枢神经系统感染的临床症状、体征,均采用脑脊液病原学检查及分离确诊感染病原微生物的种类,同时对脑脊液和血清标本进行降钙素原的检测。整理并记录60例患者的脑脊液病原学检查结果和降钙素原检测结果。以脑脊液病原学检测结果为金标准,血清和脑脊液降钙素原大于0.5ng/mL为感染阳性,采用四格诊断表,输入降钙素原检测结果和脑脊液病原微生物检测数据,分析并计算血清、脑脊液降钙素原对中枢神经系统感染判断的一致性,分析降钙素原脑脊液和血清检测方法对病原微生物检测的灵敏度、特异度和准确度。结果 31例患者为细菌性感染,22例患者为病毒性感染,7例患者未检出病原菌,阳性率为88.34%。血清降钙素原检测:阳性49例、阴性11例;脑脊液降钙素原检测:阳性37例、阴性23例。血清降钙素原与脑脊液病原学检测结果一致性检验的Kappa系数为0.769,血清降钙素原和脑脊液病原学检查结果具有较高的一致性;脑脊液降钙素原与脑脊液病原学检测结果的Kappa系数为0.315,脑脊液降钙素原和脑脊液病原学检查结果一致性较差。血清降钙素原对中枢神经系统细菌感染诊断的灵敏度为96.08%,准确度为93.33%,特异度为77.78%,脑脊液降钙素原对中枢神经系统细菌感染诊断的灵敏度为73.33%,准确度为45.00%,特异度为38.46%;血清降钙素原检测对成年中枢神经系统感染的诊断具有更高的临床价值,脑脊液降钙素原检测的诊断价值不大。结论血清降钙素原检测方法对成年人中枢神经系统感染诊断的灵敏度、准确度和特异度较高,对患者治疗方案的选择及治疗效果的评价具有较好的指导作用,对成年人中枢神进系统细菌性感染患者具有较高的临床价值。

Objective To analyze the clinical value of serum and cerebrospinal fluid（CSF）procalcitonin in the diagnosis of adult central nervous system（CNS）infection to provide reference for its clinical diagnosis and treatment.Methods Sixty adult patients with CNS diseases admitted to our hospital from February to December 2015 were selected as the research subjects.All patients were suspected of CNS infection at initial visiting due to suspected CNS symptoms and signs,and the CSF pathogenic examination and separation were performed to determine the types of infected pathogenic microorganisms.Meanwhile serum and CSF procalcitonin was detected.The detection results of CSF pathogen and procalcitonin were summarized.The detection results of CSF pathogen served as the gold standard,serum and CSF procalcitonin 〉0.5ng/mL as infection positive.The diagnostic test fourfold table was adopted.Then the procalcitonin detection results and CSF pathogenic microorganism detection data were inputted.The consistency of serum and CSF procalcitonin for judging CNS infection was analyzed and calculated.The sensitivity,specificity and accuracy of serum and CSF procalcitonin detection method for detecting pathogenic microorganisms were analyzed.Results Among 60 cases,31cases were bacterial infection,22 cases were viral infection and no pathogenic bacterium was detected out in 7cases,the positive rate was 88.34%.In the serum procalcitonin detection：49cases were positive and 11 cases were negative;in CFS procalcitonin detection：37cases were positive and 23 cases were negative.The Kappa coefficients of serum procalcitonin and CFS pathogenic detection results was 0.769,indicating that serum procalcitonin and CFS pathogenic detection results had higher consistency;the Kappa coefficients of CSF procalcitonin and CFS pathogenic detection results was 0.315,indicating that CFS procalcitonin and CFS pathogenic detection results had poor consistency.The sensitivity,accuracy and specificity of serum procalcitonin for diagnosing CNS infection were 96.08%,93.33% and 77.78%respectively,which of CSF procalcitonin were 73.33%,45.00%and 38.46%respectively;serum procalcitonin detection had a higher clinical value in the diagnosis of adult CNS infection,while CSF procalcitonin detection had little value.Conclusion The serum procalcitonin detection method has higher sensitivity,accuracy and specificity for the diagnosis of adult CNS infection,possesses a better guidance role in selecting the treatment scheme and evaluating the curative effect,and has higher clinical value in adult patients with CNS bacterial infection.