经鼻蝶窦垂体瘤术后颅内感染的高危因素及早期动态监测血清PCT、FBG及CRP水平的临床意义

HIGH-RISK FACTORS OF POSTOPERATIVE INTRACRANIAL INFECTION AFTER PITUITARY TUMOR SURGERY OF TRANSNASAL-SPHENOIDAL APPROACH AND CLINICAL SIGNIFICANCE OF EARLY DYNAMIC MONITORING ON SERUM PCT,FBG AND CRP LEVELS

目的探究经鼻蝶窦垂体瘤术后颅内感染的高危因素及早期动态监测血清降钙素原(PCT)、纤维蛋白原(FBG)、C反应蛋白(CRP)水平的临床意义。方法选择2013年3月—2019年12月于该省二所医院行内镜下经鼻蝶窦入路脑垂体瘤切除术的303例垂体瘤患者纳入研究,进行回顾性分析,收集患者临床资料,包括术前、术后1、3、7 d时空腹外周静脉血血清PCT、FBG及CRP水平,统计术后颅内感染发生情况。结果 (1)303例患者共26例患者发生颅内感染,感染率为8.58%;脑脊液菌培养共分离出病原菌株30株,其中革兰阴性菌14株(46.67%),革兰阳性菌16株(53.33%)。(2)单因素及多因素分析显示,合并糖尿病、肿瘤直径≥3 cm、手术时间≥1 h及术后脑脊液漏是患者术后颅内感染的独立危险因素(均P<0.05);术前使用抗菌药物为颅内感染的保护因素(P<0.05)。(3)随时间延长,感染组患者术后血清PCT、FBG、CRP水平均逐渐升高(均P<0.05);未感染组患者血清CRP、FBG水平均先升高后降低(均P<0.05),血清PCT手术前后无明显变化(P>0.05);感染组患者术后3、7d时血清PCT、FBG及CRP水平均高于未感染组患者(均P<0.05)。(4)ROC曲线显示,术后3d血清PCT、FBG及CRP诊断颅内感染的曲线下面积分别为0.834、0.739、0.690,其中血清PCT诊断效能最高,最佳诊断截断点为0.65ng/ml;术后7d血清PCT、FBG及CRP诊断颅内感染的曲线下面积分别为0.852、0.826、0.769,血清PCT诊断效能最高,最佳诊断截断点为0.71ng/ml。结论经鼻蝶窦入路垂体瘤切除术有一定颅内感染风险,糖尿病、肿瘤直径、手术时间、脑脊液漏及预防性抗菌药物使用情况均是其影响因素,临床宜早期筛选高危人群,采取预防性干预措施;另外术后动态监测血清PCT、FBG及CRP可早期辅助颅内感染的诊断。

Objective To explore high-risk factors of postoperative intracranial infection after pituitary tumor surgery of transnasal-sphenoidal approach and clinical significance of early dynamic monitoring on levels of serum procalcitonin(PCT),fibrinogen(FBG) and C-reactive protein(CRP).Methods Three hundred and three patients with pituitary tumor who underwent endoscopic pituitary tumor resection of transnasal-sphenoidal approach in Guang’an people’s hospital from March 2013 to December 2019 were enrolled as study objects.The clinical data were collected.Before and at 1 d, 3 d and 7 d after surgery, fast peripheral venous blood was collected.The levels of serum PCT,FBG and CRP were measured.The incidence of postoperative intracranial infection was statistically analyzed.Results(1)There were 26 cases with intracranial infection in 303 patients, with infection rate of 8.58%.There were 30 strains of pathogens isolated out from cerebrospinal fluid(CSF) culture, including 14 strains of Gram-negative bacteria(46.67%),and 16 strains of Gram-positive bacteria(53.33%).(2)Univariate and multivariate analysis showed that diabetes mellitus, tumor diameter not shorter than 3 cm, operation time not shorter than 1 h and postoperative CSF leakage were independent risk factors for postoperative intracranial infection(P<0.05),while preoperative usage of antibiotics was a protective factors(P<0.05).(3)With prolongation of time, levels of serum PCT,FBG and CRP were increased gradually in infection group(P<0.05).The levels of serum CRP and FBG were increased first and then decreased in non-infection group(P<0.05).There was no significant change in serum PCT before and after surgery(P>0.05).At 3 d and 7 d after surgery, levels of serum PCT,FBG and CRP in infection group were significantly higher than those in non-infection group(P<0.05).(4) ROC curves showed that areas under the curve(AUC) of PCT,FBG and CRP in diagnosis of intracranial infection at 3 d after surgery were 0.834,0.739 and 0.690,respectively.The diagnostic efficiency of serum PCT was the highest.The optimal diagnostic cut-off value was 0.65 ng/ml.At 7 d after surgery, AUC of PCT,FBG and CRP in diagnosis of intracranial infection were 0.852,0.826 and 0.769,respectively.The diagnostic efficiency of serum PCT was the highest.The optimal diagnostic cut-off value was 0.71 ng/ml.Conclusion There is certain intracranial infection risk of pituitary tumor resection through transnasal-sphenoidal approach.Diabetes mellitus, tumor diameter, operation time, CSF leakage and usage of prophylactic antibiotics are all its influencing factors.It is advisable to screen high-risk groups early, and take preventive intervention measures.In addition, postoperative dynamic monitoring on serum PCT,FBG and CRP can early assist diagnosis of intracranial infection.