血清及脑脊液降钙素原在神经外科术后颅内感染早期诊断中的应用

Value of procalcitonin in serum and cerebrospinal fluid to diagnosis of intracranial infection early after craniotomy

目的探讨血清及脑脊液降钙素原(PCT)在神经外科术后颅内感染早期诊断中的价值。方法 2013年9月至2015年9月北京天坛医院神经外科术后保留术腔/脑室引流的病人共90例,术后第1、3、5、7、10天经引流管留取脑脊液,同时取空腹静脉血进行PCT检测。结果术后确诊颅内感染40例(感染组),无颅内感染50例(无感染组)。感染组脑脊液PCT水平先升高,后降低;而无感染组呈逐渐降低趋势。术后第1天,感染组与无感染组脑脊液PCT水平无统计学差异(P%0.05);术后第3天,感染组脑脊液PCT水平明显高于无感染组(P<0.05);随后,两组脑脊液PCT水平无统计学差异(P%0.05)。两组术后血清PCT水平均呈逐渐下降趋势。术后1、5、7 d,观察组血清PCT水平明显高于对照组(P<0.05)。以脑脊液PCT≥0.17 ng/ml为界,诊断颅内感染的敏感度为72.2%,特异度为89.6%;以血清PCT≥0.21 ng/ml为界,诊断颅内感染的敏感度为83.3%,特异度为100%。结论术后第1天脑脊液PCT、升高,可能与手术炎性刺激有关。术后第3天脑脊液PCT增高可作为预测颅内感染的指标。

Objective To investigate the value of serum and cerebrospinal fluid （CSF） procalcitonin （PCT） in the early diagnosis of intracranial infection after the craniotomy. Methods The levels of the serum and CSF PCT were determined 1, 3, 5, 7 and 10 days after the operation in 90 patients receiving the craniotomy from September, 2013 to September, 2015, of whom, 40 suffered from intracranial infection （infection group） and 50 not （no infection group）. Results The levels of CSF PCT of the infection group were increased first and then decreased, while the no infection group decreased gradually. There was no significant difference in the level of CSF PCT between the two groups 1 day after operation （P〉0.05）. Three days after operation, the level of CSF PCT in the infection group was significantly higher than that in the no infection group （P〈0.05）. There was no significant difference in the level of CSF PCT between the two groups 5, 7 and 10 days after operation （P〉0.05）. The levels of serum PCT in the two groups were gradually decreased after operation. The level of serum PCT in the infection group was significantly higher than that in the no infection group 1, 5 and 7 days after operation （P〈0.05）. The sensitivity and specificity of the level of CSF PCT ≥0.17 ng/ml to diagnosis of intracranial infection early after the operation were 72.2% and 89.6% according to the receiver operator characteristic curve, respectively. The sensitivity and specificity of the serum PCT≥0.21 ng/ml to diagnosis of intracranial infection early after the operation were 83.3% and 100% according to the receiver operator characteristic curve, respectively. Conclusion The CSF increased in the first day after operation may be related to the inflammatory stimulation after the craniotomy. The increase in the level of CSF PCT 3 days after the operation is possible to predict the occurrence of intracranial infection.