神经外科术后颅内感染影响因素及脑脊液PCT和CXCL10水平及其诊断价值

Influencing factors of intracranial infection after neurosurgery,cerebrospinal fluid PCT and CXCL10 and their diagnostic value

目的探究神经外科术后颅内感染影响因素及脑脊液降钙素原(PCT)和白细胞计数(WBC)与CXC趋化因子配体10(CXCL10)及其诊断价值。方法选择2016年3月-2021年4月新疆医科大学第五附属医院收治的神经外科术后颅内感染患者81例作为感染组,选择同期收治的神经外科术后无颅内感染患者73例作为无感染组:分析感染组患者脑脊液病原菌培养情况,采用多因素Logistic回归分析归纳神经外科手术患者术后颅内感染的影响因素;并分析PCT和CXCL10、WBC对神经外科术后颅内感染的诊断鉴别效能。结果脑脊液共培养分离病原菌81株,其中革兰阳性菌47株占58.02%,以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主;革兰阴性菌34株占41.98%,以鲍氏不动杆菌和肺炎克雷伯菌为主;感染组患者脑脊液PCT、CXCL10及WBC高于无感染组(P<0.05);行脑室外引流和发生脑脊液外漏及PCT、CXCL10和WBC是神经外科患者术后颅内感染的影响因素(P<0.05);颅内感染革兰阳性菌患者脑脊液PCT、CXCL10和WBC低于革兰阴性菌感染患者(P<0.05);受试者工作特征(ROC)曲线结果示:脑脊液PCT、CXCL10和WBC指导鉴别是否并发颅内感染具有较高效能,且鉴别神经外科术后患者革兰阳性菌与革兰阴性菌颅内感染也均有较高效能,其中PCT对于革兰阳性菌与革兰阴性菌感染的区分有更为明显的鉴别价值,其约登指数为0.624,对应cut-off值为1.85μg/L,曲线下面积(AUC)为0.807,敏感度、特异性分别为82.98%、79.41%。结论脑室外引流和发生脑脊液外漏以及PCT、CXCL10和WBC异常高表达均是神经外科术后患者出现颅内感染的影响因素,且神经外科术后颅内感染患者脑脊液PCT、CXCL10和WBC对于不同病原菌属的鉴别指导效能较高。

OBJECTIVE To investigate the factors affecting intracranial infection after neurosurgery and the changes of cerebrospinal fluid procalcitonin(PCT),white blood cell count(WBC)and CXC chemokine ligand 10(CXCL10)and their diagnostic value.METHODS Totally 81 patients with intracranial infection after neurosurgery treated in The Fifth Affiliated Hospital of Xinjiang Medical University between Mar.2016 and Apr.2021 were selected as the infection group,and 73 patients without intracranial infection after neurosurgery treated during the same period were selected as the non-infection group.The culture of cerebrospinal fluid pathogenic bacteria in the infection group was analyzed.Multivariate Logistic regression analysis was used to summarize the influencing factors of postoperative intracranial infection in patients undergoing neurosurgery.The differential diagnostic efficiency of PCT,CXCL10 and WBC on intracranial infection after neurosurgery was analyzed.RESULTS A total of 81 strains of pathogenic bacteria were isolated and cultured from cerebrospinal fluid,among which 47 strains of Gram-positive bacteria accounted for 58.02%,mainly coagulase negative Staphylococcus and Staphylococcus aureus,and 34 strains of Gram-negative bacteria accounted for 41.98%,mainly Acinetobacter baumannii and Klebsiella pneumoniae.The levels of PCT,CXCL10 and WBC in the cerebrospinal fluid of the infection group were higher than those of the non-infection group(P<0.05).External ventricular drainage,occurrence of cerebrospinal fluid leakage and PCT,CXCL10 and WBC were the influencing factors of postoperative intracranial infection in patients undergoing neurosurgery(P<0.05).The levels of PCT,CXCL10 and WBC in the cerebrospinal fluid of patients with intracranial infection of Gram-positive bacteria were lower than those of patients with Gram-negative bacteria infection(P<0.05).Receiver operating characteristic(ROC)curve results showed that cerebrospinal fluid PCT,CXCL10 and WBC had high efficiency in guiding the identification of intracranial infection,and also had high efficiency in distinguishing Gram-positive and gram-negative bacterial intracranial infections in patients after neurosurgery.Among them,PCT had a more obvious discriminatory value for differentiating Gram-positive bacteria from gram-negative bacterial intracranial infections,with a Youden index of 0.624,corresponding cut-off value of 1.85μg/L,an area under the curve(AUC)of 0.807,and a sensitivity and specificity of 82.98%and 79.41%,respectively.CONCLUSION External ventricular drainage,occurrence of cerebrospinal fluid leakage,as well as abnormally high expressions of PCT,CXCL10 and WBC were all influencing factors in the development of intracranial infections in patients after neurosurgery.In addition,PCT,CXCL10 and WBC in the cerebrospinal fluid of patients with intracranial infection after neurosurgery had high guiding efficiency in distinguishing different pathogenic bacteria.