降钙素原在神经外科术后颅内感染评估中的应用价值

Application value of procalcitonin in evaluation of intracranial infection after neurosurgery

目的探讨降钙素原(PCT)在神经外科术后颅内感染评估中的应用价值。方法选取2015年1月至2019年10月在鄞州人民医院行开颅手术且术后怀疑颅内感染的75例患者为研究对象,其中确诊颅内感染45例(观察组),无菌性脑膜炎30例(对照组)。比较两组患者脑脊液及血清PCT等指标,同时利用ROC曲线分析上述指标对神经外科术后颅内感染的诊断效能;分析颅内感染患者抗感染治疗情况,比较治愈与未治愈患者治疗后脑脊液PCT动态监测结果;分析颅内感染患者脑脊液病原菌结果,比较检出革兰阳性菌与阴性菌患者脑脊液PCT水平。结果与对照组比较,观察组患者脑脊液PCT水平、脑脊液PCT/血清PCT比值明显升高,脑脊液葡萄糖、氯化物水平均明显降低,差异均有统计学意义(均P<0.05);两组患者血清PCT水平以及脑脊液蛋白、WBC水平比较,差异均无统计学意义(均P>0.05)。脑脊液PCT水平、脑脊液PCT/血清PCT比值以及脑脊液葡萄糖、氯离子水平对神经外科术后颅内感染均有诊断价值(均P<0.05),诊断效能从高到低为脑脊液PCT/血清PCT比值(AUC=0.91)、脑脊液PCT水平(AUC=0.88)、脑脊液氯离子(AUC=0.79)、脑脊液葡萄糖(AUC=0.78)。颅内感染患者经抗生素等综合治疗后,治愈36例,未治愈9例。抗感染治疗第0、1、3天,治愈与未治愈患者脑脊液PCT水平比较,差异均无统计学意义(均P>0.05);抗感染治疗第5、7、14天,治愈患者脑脊液PCT水平明显低于未治愈患者(均P<0.05)。经细菌学培养及二代基因测序,45例颅内感染患者中检出病原菌19例,包括革兰阳性菌8例、革兰阴性菌11例。检出革兰阳性菌与阴性菌的患者脑脊液PCT水平比较,差异无统计学意义(P>0.05)。结论早期动态监测脑脊液PCT有助于神经外科术后颅内感染的诊断,并能评估抗感染治疗效果。

Objective To explore the value of procalcitonin(PCT)in the evaluation of intracranial infection after neurosurgery.Methods Seventy-five patients,who were admitted to ICU after craniotomy and suspected as intracranial infection after surgery in Yinzhou People’s Hospital from January 2015 to October 2019,were enrolled in the study.Among them 45 cases were eventually diagnosed as intracranial infection(study group)and 30 cases were diagnosed as aseptic meningitis(control group).The PCT levels in cerebrospinal fluid(CSF)and serum of two groups of patients were compared,and the diagnostic efficacy of the above indicators for intracranial infection after neurosurgery was analyzed with ROC curve.The anti-infection treatment of patients with intracranial infection was analyzed.The pathogens in CSF of patients with intracranial infection were analyzed,and the PCT levels in CSF of patients with Gram-positive bacteria and negative bacteria were compared.Results Compared with the control group,the CSF PCT level and CSF PCT/serum PCT ratio of study group were significantly increased,and the levels of glucose and chloride in the CSF were significantly reduced(both P<0.05).There was no significant difference in the levels of CSF protein and WBC(both P>0.05).CSF PCT levels,CSF PCT/serum PCT ratios,and CSF glucose and chloride ion levels had diagnostic value for intracranial infections after neurosurgery(both P<0.05).The diagnostic efficacy of CSF PCT/serum PCT ratio was the highest(AUC=0.91),followed by CSF PCT level(AUC=0.88),CSF chloride ion(AUC=0.79)and CSF glucose(AUC=0.78).After treatment with antibiotics,36 patients with intracranial infection were cured,and 9 patients failed.On the 0th,1st and 3rd day of anti-infection treatment,there was no significant difference in CSF PCT levels between the cured group and failure group(all P>0.05).On the 5th,7th and 14th day of anti-infection treatment,the PCT level in CSF of the cured group was significantly lower than that of the failue group(both P<0.05).After bacteriological cultivation and second-generation gene sequencing,pathogens were detected in 19 of 45 patients with intracranial infection,including 8 cases of Gram-positive bacteria and 11 cases of Gram-negative bacteria.There was no significant difference in PCT levels in CSF between patients with Gram-positive and negative bacteria(P>0.05).Conclusion Early and dynamic monitoring of CSF PCT can be used for the diagnosis of intracranial infections after neurosurgery and the evaluation of anti-infective treatment effects.