S-100b蛋白、可溶性白介素-2受体水平与颅内感染合并脑梗死的相关性及预后预测价值

Correlation between S-100b protein,soluble interleukin-2 receptor level and intracranial infection complicated with cerebral infarction and its prognostic value

目的探讨S-100b蛋白、可溶性白介素-2受体(sIL-2R)水平与颅内感染合并脑梗死的相关性及预后预测价值。方法回顾性选取2017年6月至2022年6月达州市中西医结合医院收治的110例创伤性颅脑损伤开颅手术后颅内感染合并脑梗死的患者作为研究对象,将其作为颅内感染合并脑梗死组,选取同期收治的110例创伤性颅脑损伤开颅手术后颅内感染但未合并脑梗死的患者作为颅内感染组,另选取同期收治的110例创伤性颅脑损伤开颅手术后未合并感染的患者作为对照组。比较3组患者S-100b蛋白、sIL-2R表达水平,分析S-100b蛋白、sIL-2R与颅内感染合并脑梗死的相关性,并建立受试者工作特征(ROC)曲线,分析S-100b蛋白联合sIL-2R对颅内感染合并脑梗死的诊断效能。对所有患者进行6个月的门诊复查随访和电话随访,依照其生存情况将患者分为存活组(n=78)和死亡组(n=32),比较存活组与死亡组患者临床一般情况,分析S-100b蛋白、sIL-2R对颅内感染合并脑梗死的预后预测价值。结果颅内感染合并脑梗死组患者S-100b蛋白、sIL-2R表达水平分别为(28.83±5.83)μg/mL、(447.28±46.93)mg/L,均明显高于颅内感染组[(24.13±5.67)μg/mL、(412.55±51.13)mg/L]和对照组[(21.02±3.53)μg/mL、(367.51±42.91)mg/L],差异均有统计学意义(P<0.05)。Spearman相关分析结果显示:S-100b蛋白、sIL-2R与颅内感染合并脑梗死呈正相关(P<0.05)。S-100b蛋白对颅内感染合并脑梗死的诊断曲线下面积为0.852,最佳诊断界限值为23.52μg/mL。sIL-2R对颅内感染合并脑梗死的诊断曲线下面积为0.835,最佳诊断界限值为404.53 mg/L,两者联合的曲线下面积为0.932。S-100b蛋白、sIL-2R联合诊断的敏感度与特异度明显高于单一诊断(P<0.05)。死亡组患者长期卧床的患者比率、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、S-100b蛋白与sIL-2R水平均高于存活组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示:S-100b蛋白、sIL-2R为颅内感染合并脑梗死的预后独立危险因素(P<0.05)。结论S-100b蛋白、sIL-2R水平与颅内感染合并脑梗死具有明显相关性,且两者联合对于颅内感染合并脑梗死的诊断价值较高,临床可考虑将两者联合作为颅内感染合并脑梗死的辅助诊断指标。同时,S-100b蛋白、sIL-2R对于颅内感染合并脑梗死具有较高的预后预测价值。

Objective To investigate the correlation between S-100b protein,soluble interleukin-2 receptor(sIL-2R)level and intracranial infection complicated with cerebral infarction and their prognostic value.Methods A total of 110 patients with intracranial infection and cerebral infarction after craniotomy of traumatic brain injury admitted in Dazhou Integrated TCM&Western Medicine Hospital from June 2017 to June 2022 were retrospectively selected as research objects,and they were divided into intracranial infection and cerebral infarction group.One hundred and ten patients with intracranial infection but not cerebral infarction after craniotomy of traumatic brain injury at the same time were selected and divided into intracranial infection group,in addition,110 patients without infection after craniotomy of traumatic brain injury admitted at the same time were divided into the control group.The expression levels of S-100b protein and sIL-2R in the three groups were compared,the correlation between S-100b protein,sIL-2R and intracranial infection with cerebral infarction was analyzed,and the diagnostic efficacy of S-100b protein combined with sIL-2R for intracranial infection with cerebral infarction was analyzed by receiver operating characteristic(ROC)curve.All patients were followed up for 6 months by outpatient reexamination and telephone.The patients were divided into survival group(n=78)and death group(n=32)according to their survival conditions.The general clinical conditions of patients in survival group and death group were compared,and the prognostic value of S-100b protein and sIL-2R for intracranial infection combined with cerebral infarction death was analyzed.Results The expression levels of S-100b protein and sIL-2R in patients with intracranial infection and cerebral infarction were(28.83±5.83)μg/mL,and(447.28±46.93)mg/L,respectively,which were significantly higher than those in the intracranial infection group[(24.13±5.67)μg/mL,(412.55±51.13)mg/L]and control group[(21.02±3.53)μg/mL,(367.51±42.91)mg/L],the differences were statistically significant(P<0.05).Spearman correlation analysis showed that S-100b protein and sIL-2R were positively correlated with intracranial infection complicated with cerebral infarction(P<0.05).The area under the diagnostic curve of S-100b protein for intracranial infection with cerebral infarction was 0.852,and the best diagnostic threshold was 23.52μg/mL.The area under the curve of sIL-2R in the diagnosis of intracranial infection with cerebral infarction was 0.835,the best diagnostic threshold was 404.53 mg/L,and the area under the curve of the combination of sIL-2R and sIL-2R was 0.932.The sensitivity and specificity of combined diagnosis of S-100b protein and sIL-2R were significantly higher than those of single diagnosis(P<0.05).The proportion of long-term bedridden patients in the death group,acute physiology and chronic health assessment systemⅡ(APACHEⅡ)score,S-100b protein and sIL-2R levels were higher than those in the survival group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that S-100b protein and sIL-2R were independent risk factors for the prognosis of cerebral infarction complicated with pulmonary infection(P<0.05).Conclusion S-100b protein and sIL-2R have obvious correlation with intracranial infection complicated with cerebral infarction,and the combination of the two has high diagnostic value for intracranial infection complicated with cerebral infarction.The combination of the two can be considered as an auxiliary diagnostic index for cerebral infarction complicated with pulmonary infection.At the same time,S-100b protein and sIL-2R have high prognostic value for cerebral infarction complicated with pulmonary infection.