HMGB-1、S100B与RAGE对创伤性颅脑损伤术后颅内感染的诊断价值

Diagnostic value of HMGB-1,S100B and RAGE for intracranial infection after traumatic brain injury

目的探讨高迁移率蛋白-1(HMGB-1)、S100B、晚期糖基化终产物受体(RAGE)对创伤性颅脑损伤(TBI)患者术后发生颅内感染的诊断价值。方法选取2014年9月至2020年9月新乡市中心医院收治的208例TBI患者,根据术后有无感染分为感染组49例、未感染组159例。分析感染组患者原菌分布情况及构成比,统计主要革兰阳性菌对抗菌药物的耐药率;分析患者术后发生颅内感染危险的相关因素,并评估联合HMGB-1、S100B、RAGE的诊断价值。结果感染组49例患者均检出病原菌,其中革兰阳性菌42株(85.71%)、革兰阴性菌7株(14.29%)。表皮葡萄球菌对青霉素、苯唑西林口头孢类常用抗菌药物耐药性高,均>50.00%;金黄色葡萄球菌、头葡萄球菌对青霉素及头孢类常用抗菌药物耐药性高,均>50.00%。感染组HMGB-1、S100B、RAGE水平高于未感染组,差异有统计学意义(P<0.05)。手术时间≧4 h、有切口脑脊液侧漏、术前GCS评分≧8分、HMGB-1异常升高、S100B异常升高、RAGE异常升高为TBI患者术后发生颅内感染的危险因素(P<0.05)。三者联合(HMGB-1+S100B+RAGE)检测敏感度(0.911)、特异度(0.985)、AUC(0.988),均显著高于单一指标检测(P<0.05)。208例患者中有55例(26.44%)预后不良,153例(73.56%)预后良好。预后良好组HMGB-1、S100B、RAGE水平均低于预后不良组,差异有统计学意义(P<0.05)。结论临床可对TBI患者进行HMGB-1、S100B、RAGE联合检测,以预测颅内感染、评估预后。

Objective To investigate the diagnostic value of high mobility protein-1(HMGB-1),S100 B and receptor for advanced glycation end products(RAGE)in postoperative intracranial infection in patients with traumatic brain injury(TBI).Methods A total of 208 TBI patients admitted to Xinxiang Central Hospital from September 2014 to September 2020 were selected and divided into an infection group of 49 cases and a non-infection group of 159 cases according to the presence or absence of postoperative infection.The distribution and composition ratio of the original bacteria in the infection group were analyzed,and the resistance rate of major Gram-positive bacteria to antibiotics was calculated.The risk factors of postoperative intracranial infection were analyzed,and the diagnostic value of combined HMGB-1,S100 B and RAGE was evaluated.Results Pathogenic bacteria were detected in all 49 patients in the infection group,including 42 gram-positive bacteria(85.71%)and 7 gram-negative bacteria(14.29%).Staphylococcus epidermidis was highly resistant to common antibiotics such as penicillin and oxacillin oral cephalosporins,all>50.00%.Staphylococcus aureus and Staphylococcus cephalococcus were highly resistance to penicillin and cephalosporins,both>50.00%.The levels of HMGB-1,S100 B,RAGE in the infected group were higher than those in the uninfected group,and the difference was statistically significant(P<0.05).Operation time≧4 h,incision cerebrospinal fluid leakage,preoperative GCS score≧8 points,abnormal increase of HMGB-1,S100 B and RAGE were the risk factors for postoperative intracranial infection in patients with severe traumatic brain injury(P<0.05).The three combined(HMGB-1+S100 B+RAGE)detection sensitivity(0.911),specificity(0.985),AUC(0.988)were significantly higher than the single indicator detection(P<0.05).Among the 208 patients,55(26.44%)had poor prognosis and 153(73.56%)had good prognosis.The levels of HMGB-1,S100 B and RAGE in the good prognosis group were lower than those in the poor prognosis group,and the difference was statistically significant(P<0.05).Conclusion The combined detection of HMGB-1,S100 B and RAGE can be performed in TBI patients to predict intracranial infection and evaluate prognosis.