血清Lp(a)、MBP、CGRP在预测脑出血术后早期颅内感染的效能研究

Efficacy of serum Lp(a),MBP and CGRP in early prediction of postoperative intracranial infection in patients with cerebral hemorrhage

目的 研究血清脂蛋白(a)、髓鞘碱性蛋白(MBP)、降钙素基因相关肽(CGRP)联合检测对脑出血患者开颅术后早期感染的临床诊断价值。方法 将绵阳市中心医院2017年1月—2020年1月之间收治的265例行开颅血肿清除术治疗的脑出血患者纳为病例组,依据开颅手术后颅内是否感染将病例组分为感染组与正常组,同时将30例健康志愿者纳为对照组,检测并比较对照组、正常组及感染组血清Lp(a)、MBP及CGRP水平,分析其在诊断颅内感染中的价值。结果 病例组血清Lp(a)、MBP及CGRP水平显著高于对照组(P <0.05);265例行开颅血肿清除术治疗的脑出血患者中,共25例发生颅内感染,感染率为9.43%(25/265),且感染组与正常组手术时间差异显著(P <0.05),其余资料无显著性差异(P> 0.05);感染组血清Lp(a)、MBP及CGRP水平显著高于正常组(P <0.05);相关性分析提示,感染组患者血清Lp(a)、MBP及CGRP水平与其脑脊液白细胞间均呈正相关(P <0.05);绘制ROC曲线提示,血清Lp(a)、MBP及CGRP单独应用时,以CGRP在诊断颅内感染中的效能最高,AUC=0.788,95%CI=0.699~0.878,CGRP+Lp(a)、CGRP+MBP在诊断颅内感染中的AUC分别为0.810及0.826,三者联合应用诊断效能最高,AUC=0.918,95%CI=0.865~0.972。结论 行开颅手术治疗的脑出血者血清Lp(a)、MBP及CGRP水平均异常升高,且并发颅内感染者血清Lp(a)、MBP及CGRP浓度高于未感染者,三者联合应用在颅内感染诊断中具有较好的效果。

Objective To investigate the clinical value of serum lipoprotein(a),myelin basic protein(MBP)and calcitonin gene-related peptide(CGRP)combined in the diagnosis of early infection after craniotomy in patients with cerebral hemorrhage.Methods 265 patients with intracerebral hemorrhage who were treated by craniotomy hematoma removal in Mianyang Central Hospital from January 2017 to January 2020 were included in the case group.The case group was divided into infection group and normal group according to whether there was intracranial infection after craniotomy.At the same time,30 healthy volunteers were included in the control group.Serum Lp(a),MBP and CGRP levels in the control group,normal group and infection group were detected and compared,and their value in diagnosing intracranial infection was analyzed.Results The serum levels of Lp(a),MBP and CGRP in the case group were significantly higher than those in the control group(P<0.05).Among the 265 patients undergoing craniotomy for hematoma removal,a total of 25 patients developed intracranial infection,with an infection rate of 9.43%(25/265).The operative time of the infected group was significantly different from that of the normal group(P<0.05),and there was no significant difference in other data(P>0.05).The levels of Lp(a),MBP and CGRP in the infected group were significantly higher than those in the normal group(P<0.05).The correlation analysis showed that the serum Lp(a),MBP and CGRP levels in the infected group were positively correlated with the CSF white blood cell levels(P<0.05).The ROC curve showed that when serum Lp(A),MBP and CGRP were applied alone,CGRP was the most effective in the diagnosis of intracranial infection,with AUC=0.788 and 95%CI=0.699-0.878,the AUC of CGRP+Lp(A)and CGRP+MBP in diagnosing intracranial infection was 0.810 and 0.826,respectively.And the combined application of the three was the most effective,with AUC=0.918 and 95%CI=0.865-0.972.Conclusion The levels of serum Lp(a),MBP and CGRP in patients with intracranial hemorrhage treated with craniotomy are abnormally elevated,and the concentrations of serum Lp(a),MBP and CGRP in patients with intracranial infection are higher than those in patients without intracranial infection.The combined application of the three has a good effect in the diagnosis of intracranial infection.