脑脊液多种酶学参数联合炎症指标对开颅术后颅内感染的诊断价值研究

The diagnostic value of cerebrospinal fluid multiple enzymatic parameters combined with inflammatory indexes in intracranial infection after craniotomy

目的研究脑脊液多种酶学参数联合炎症指标对开颅术后颅内感染的诊断价值。方法回顾性分析2017年12月至2020年12月在浙江衢化医院和开化县人民医院行开颅术的56例患者的临床资料,其中出现颅内感染的17例设定为感染组,未出现颅内感染的39例设定为未感染组。脑脊液酶学参数使用全自动生化分析仪检测,炎症指标C反应蛋白(CRP)使用免疫比浊法检测、白细胞(WBC)计数使用显微镜与计数板人工计数、脑脊液总蛋白(TP)与葡萄糖(Glu)使用终点法检测、中性粒细胞(NEUT)分类使用瑞氏染液显微镜人工镜检。相关指标的曲线下面积(AUC)通过ROC曲线计算,选择Logistic回归分析相关指标的诊断性能。结果感染组ADA、α-HBDH、CK-MB、GLDH、LDH、ACP、CK水平明显高于未感染组,差异有统计学意义(P<0.05);感染组CRP、WBC、TP、NEUT水平明显高于未感染组,差异有统计学意义(P<0.05);两组Glu水平相比,差异无统计学意义(P>0.05);LDH、CK-MB、α-HBDH、GLDH联合检测的AUC为0.772,上述指标同ADA、ACP联合检测的AUC为0.795,同炎症指标WBC、TP、NEUT联合检测的AUC为0.851。结论脑脊液多种酶学参数联合炎症指标在筛查开颅术后颅内感染方面价值较高。

Objective To study the diagnostic value of various enzymatic parameters of cerebrospinal fluid combined with inflammatory markers in intracranial infection after craniotomy.Methods The clinical data of 56 patients who underwent craniotomy in our hospital from December 2017 to December 2020 were retrospectively analyzed.Among them,17 patients with intracranial infection were set as the infection group,and39 patients without intracranial infection were set as the uninfected group.Cerebrospinal fluid enzymatic parameters were detected by automatic bio-chemical analyzer,inflammatory index C-reactive protein(CRP)was detected by immunoturbidimetry,white blood cell(WBC)count was manually counted by microscope and counting plate,cerebrospinal fluid total protein(TP)and glucose(Glu)were detected using the end-point method,and neutrophils(NEUT)were classified by manual microscopy using Wright’s stain.The area under the curve(AUC)of the relevant indicators was calcu-lated by the ROC curve,and Logistic regression was selected to analyze the diagnostic performance of the relevant indicators.Results The levels of ADA,ɑ-HBDH,CK-MB,GLDH,LDH,ACP,and CK in the infected group were significantly higher than those in the uninfected group,and the difference were statistically significant(P<0.05).The levels of CRP,WBC,TP,and NEUT in the infected group were significantly higher than the unin-fected group,the difference were statistically significant(P<0.05).There was no significant difference in Glu levels between the two groups(P>0.05).The AUC of the combined detection of LDH,CK-MB,α-HBDH and GLDH was 0.772,the AUC of the above indicators combined with ADA and ACP was 0.795,and the AUC of the combined detection of inflammatory indicators WBC,TP and NEUT was 0.851.Conclusion The combination of various enzymatic parameters of cerebrospinal fluid and inflammatory indicators is of high value in screening for intracranial infection after craniotomy.