脑出血血肿清除术后颅内感染影响因素及脑脊液NT-proBNP、NSE、LDH预测价值

Influencing factors for postoperative intracranial infection in cerebral hemorrhage patients undergoing hematoma evacuation and predictive value of cerebrospinal fluid NT-proBNP,NSE and LDH

目的 分析脑出血血肿清除术后颅内感染影响因素,探讨脑脊液N端脑钠肽前体(NT-proBNP)、神经元特异性烯醇化酶(NSE)、乳酸脱氢酶(LDH)对术后颅内感染的预测价值。方法 选取2017年1月-2020年12月台州市中心医院307例急性脑出血行血肿清除术患者,其中术后30 d颅内感染28例为感染组,279例为非感染组,分析颅内感染病原菌分布及影响因素,比较两组患者术后第2天脑脊液NT-proBNP、NSE、LDH水平差异及其预测术后颅内感染的临床价值。结果 28例颅内感染患者共分离36株病原菌,其中革兰阳性菌24株(66.67%)、革兰阴性菌11株(30.56%)、真菌1株(2.78%),多因素Logistic回归分析显示引流管留置时间、术前格拉斯哥昏迷评分(GCS)是导致急性脑出血患者血肿清除术后发生颅内感染的影响因素(P<0.05)。感染组术后第2天脑脊液NT-proBNP、NSE、LDH水平高于非感染组(P<0.05),联合检测预测急性脑出血血肿清除术后颅内感染的曲线下面积为0.843。结论 急性脑出血血肿清除术后发生颅内感染患者术后第2天脑脊液NT-proBNP、NSE、LDH水平高于未发生颅内感染患者,三者联合可作为预测颅内感染的生物标志物。

OBJECTIVE To investigate the influencing factors for postoperative intracranial infection in cerebral hemorrhage patients undergoing hematoma evacuation and explore the values of cerebrospinal fluid N-terminal pro-brain natriuretic peptide(NT-proBNP), neuron specific enolase(NSE) and lactate dehydrogenase(LDH) in prediction of postoperative intracranial infection. METHODS A total of 307 acute cerebral hemorrhage patients who underwent hematoma evaluation in the Taizhou Central Hospital from Jan 2017 to Dec 2020 were enrolled in the study, 28 of whom had intracranial infection after surgery for 30 days and were assigned as the infection group, and 279 patients were assigned as the no infection group. The distribution of pathogens and influencing factors for the intracranial infection were observed, the levels of cerebrospinal fluid NT-proBNP, NSE and LDH were compared between the two groups of patients on the second day after surgery, and the clinical values of the above indexes in prediction of postoperative intracranial infection were analyzed. RESULTS Totally 36 strains of pathogens were isolated from 28 patients with intracranial infection, 24(66.67%) of which were gram-positive bacteria, 11(30.56%) were gram-negative bacteria, and 1(2.78%)was fungus. Multivariate logistic regression analysis showed that drainage tube indwelling time and preoperative GCS score were the influencing factors for the postoperative intracranial infection in the acute cerebral hemorrhage patients undergoing hematoma evacuation(P<0.05). The levels of cerebrospinal fluid NT-proBNP, NSE and LDH of the infection group were higher than those of the no infection group on the second day after surgery(P<0.05), and the area under curve of the combined detection of the above indexes was 0.843 in prediction of postoperative intracranial infection in the acute cerebral hemorrhage patients undergoing hematoma evacuation. CONCLUSION The levels of cerebrospinal fluid NT-proBNP, NSE and LDH of the acute cerebral hemorrhage with intracranial infection are higher than those of the patients without intracranial infection on the second day after hematoma evacuation, and the joint detection of the three biomarkers can be used for prediction of Intracranial infection.