脑脊液实验室指标对高血压脑出血术后颅内感染的诊断价值

Comparisons of the diagnostic value of cerebrospinal fluid laboratory indexes for intracranial infection after operation of hypertensive intracerebral hemorrhage

目的:对比分析脑脊液实验室指标对高血压脑出血(hypertensive intracerebral hemorrhage,HICH)术后颅内感染的诊断价值,为医院感染的诊断提供依据。方法:选取2018年10月至2021年4月海口市人民医院神经外科收治的130例HICH术后拟诊颅内感染患者,根据最终是否确诊术后颅内感染将其分为感染组(86例)与未感染组(44例)。对两组患者的临床资料及葡萄糖、总蛋白质、氯离子、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、乳酸(lactate acid,LAC)、乳酸脱氢酶(lactate dehydrogenase,LDH)、腺苷脱氨酶(adenosine deaminase,ADA)等脑脊液实验室指标进行比较。结果:感染组患者的合并糖尿病比例、手术时间、术后引流时间均高于未感染组(均P<0.05)。感染组患者脑脊液总蛋白质、PCT、CRP、NSE、ADA水平均高于未感染组(均P<0.05),脑脊液葡萄糖、氯离子水平均低于未感染组(均P<0.05)。脑脊液NSE诊断HICH术后颅内感染的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)和诊断灵敏度最高,分别为0.816(P<0.05)和0.930,葡萄糖、总蛋白质、氯离子的诊断特异度均为1.000。结论:在应用脑脊液实验室指标诊断HICH术后颅内感染中,葡萄糖、总蛋白质、氯离子虽然具有较高的特异度,但较低的灵敏度限制了其临床应用,NSE和PCT等指标具有较高的诊断灵敏度,可作为联合诊断辅助指标,以达到提高诊断效率的目的。

Objective:To compare and analyze the diagnostic values of cerebrospinal fluid laboratory indexes for postoperative intracranial infection of hypertensive intracerebral hemorrhage (HICH) to provide basis for the diagnosis of nosocomial infections. Methods: A total of 130 patients with HICH complicated with suspected intracranial infection after surgery in Neurology Department of Haikou People’s Hospital from October 2018 to April 2021 were selected as the research subjects and divided into an infection group (86 cases) and a non-infection group (44 cases) according to the final diagnosis of intracranial infection. The clinical data and the laboratory indexes in cerebrospinal fluid such as glucose, protein, chloride ion, procalcitonin (PCT), C-reactive protein (CRP), neuron specific enolase (NSE), lactate acid (LAC), lactate dehydrogenase (LDH), adenosine deaminase (ADA) between the 2 groups were compared. Results: The proportion of diabetes mellitus, the operation time and the postoperative drainage time of the patients in the infection group were higher than those in the non-infection group (all P<0.05). The levels of protein, PCT, CRP, NSE, and ADA in cerebrospinal fluid of the patients in the infection group were higher than those in the non-infection group (all P<0.05). The levels of glucose and chloride ion in cerebrospinal fluid were lower than those in the non-infection group (both P<0.05). The area under curve (AUC) of receiver operating characteristic (ROC) and the sensitivity of NSE in cerebrospinal fluid in the diagnosis of postoperative intracranial infection after HICH were the highest, with 0.816 (P<0.05) and 0.930, respectively. The diagnostic specificities of glucose, protein, and chloride ion were all 1.000. Conclusion: In the application of cerebrospinal fluid laboratory indicators in the diagnosis of postoperative intracranial infection after HICH, although glucose, protein and chloride ion have high specificity, low sensitivity limits their clinical application. NSE and PCT have high diagnostic sensitivities, which can be used as combined diagnostic auxiliary indicators to improve the diagnostic efficiency.