动态监测血清相关指标对重型颅脑损伤术后肺部感染的预测价值

Predictive value of dynamic monitoring of serum related indexes for pulmonary infection after severe craniocerebral injury

目的分析动态监测重型颅脑损伤术后患者血清降钙素原(PCT)、可溶性髓样细胞表达的激发受体-1(sTREM-1)及C反应蛋白与白蛋白比值(CRP/ALB)的变化对肺部感染的早期预测价值。方法选取手术治疗的196例重型颅脑损伤患者,监测并记录术后1、3、5 d的血清PCT、CRP、ALB、sTREM-1及CRP/ALB水平,记录患者术后肺部感染情况。分析重型颅脑损伤术后肺部感染的危险因素,通过绘制受试者工作特征(ROC)曲线分析相关指标对肺部感染的早期预测价值。结果重型颅脑损伤术后发生肺部感染者76例(38.78%),感染发生时间为术后6~13 d,中位数为7 d。无肺部感染组术后3、5 d血清PCT、sTREM-1及CRP/ALB低于肺部感染组,差异有统计学意义(P<0.05);肺部感染组术后5 d血清ALB低于无肺部感染组,差异有统计学意义(P<0.05)。机械通气时间、术后格拉斯哥昏迷量表(GCS)评分、术后急性生理与慢性健康评分Ⅱ(APACHEⅡ)以及术后5 d血清PCT、sTREM-1及CRP/ALB是术后肺部感染的独立危险因素(P<0.05)。ROC曲线显示,单独检测时,术后5 d血清CRP/ALB预测肺部感染的曲线下面积(AUC)值、约登指数、特异度最高,sTREM-1预测的敏感度最高;联合检测的AUC、约登指数、灵敏度、特异度均高于单独检测。肺部感染诊断时临床肺部感染评分(CPIS)、全身炎症反应综合征修正(ASS)评分均与术后5 d PCT、sTREM-1、CRP/ALB水平呈显著正相关(P<0.05)。结论术后5 d血清PCT、sTREM-1及CRP/ALB水平均可作为重型颅脑损伤术后肺部感染早期预测的有效依据,而联合检测的预测价值更高,更有利于早期对肺部感染程度及病情进展的评估。

Objective To analyze the value of dynamic monitoring of serum procalcitonin(PCT),soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and ratio of C-reaction protein to albumin(CRP/ALB)changes in early predicting pulmonary infection after severe craniocerebral injury.Methods A total of 196 patients with severe craniocerebral injury treated by surgery were selected,the serum PCT,CRP,ALB,sTREM-1 and CRP/ALB levels at 1 day,3 and 5 days after operation were monitored and recorded,and the postoperative pulmonary infection conditions were recorded as well.Risk factors for pulmonary infection after severe craniocerebral injury were analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the early predictive value of related indicators for pulmonary infection.Results There were 76 cases(38.78%)with pulmonary infection after operation for severe craniocerebral injury,and the infection occurred at 6 to 13 days after operation with a median of 7 days.The levels of serum PCT,sTREM-1 and CRP/ALB in the non-pulmonary infection group were significantly lower than those in the pulmonary infection group at 3 and 5 days after operation(P<0.05).The serum ALB in the pulmonary infection group was significantly lower than that in the non-pulmonary infection group at 5 days after operation(P<0.05).The time of mechanical ventilation,postoperative Glasgow Coma Scale(GCS)score,postoperative Acute Physiology and Chronic Health ScoreⅡ(APACHEⅡ)and serum PCT,sTREM-1 and CRP/ALB at 5 days after operation were the independent risk factors for postoperative pulmonary infection(P<0.05).ROC curve showed that area under curve(AUC),Youden index and specificity of single detection of serum CRP/ALB were the highest in predicting pulmonary infection at 5 days after operation,and the sTREM-1 was the most sensitive.The Clinical Pulmonary Infection Score(CPIS)and modified Systemic Inflammatory Response Syndrome Score(ASS)were positively correlated with the levels of PCT,sTREM-1 and CRP/ALB at 5 days after operation(P<0.05).Conclusion The serum PCT,sTREM-1 and CRP/ALB levels at 5 days after operation can be used as the effective evidences for early prediction of pulmonary infection after severe craniocerebral injury,and the combined detection is more valuable and conducive to the early assessment of the degree of pulmonary infection and the progress of the disease.