脑出血患者术后颅内感染病原菌分布及血清Apelin-13、Netrin-1联合检测的预测价值

The distribution of pathogenic bacteria in postoperative intracranial infections in patients with cerebral hemorrhage and the predictive value of combined detection of serum Apelin-13 and Netrin-1

目的探究脑出血患者术后颅内感染的病原菌分布及血清血管紧张素II受体样1受体内源性配体13(Apelin-13)、神经导向因子(Netrin-1)联合检测的预测价值。方法选取2019年3月~2023年3月本院行开颅血肿清除术的64例脑出血患者为研究对象,根据术后是否发生颅内感染分为感染组(14例)和非感染组(50例);使用全自动免疫分析仪鉴定病原菌;采用酶联免疫吸附法(ELISA)检测血清Apelin-13、Netrin-1水平;采用Logistic回归分析脑出血患者术后颅内感染的影响因素;受试者工作特征(ROC)曲线分析血清Apelin-13、Netrin-1联合对脑出血患者术后颅内感染的预测价值。结果感染组14例患者共分离出26株菌株,其中革兰阴性菌9株(34.62%),革兰阳性菌14株(53.85%),真菌3株(11.54%)。患者术前GCS评分、引流管留置时间、切口皮下积液和预防性使用抗生素差异有统计学意义(P<0.05)。感染组血清Apelin-1、Netrin-1水平显著低于非感染组(P<0.05)。轻度、中度和重度组血清Apelin-13、Netrin-1水平依次降低(P<0.05)。根据Logistic回归分析得知Apelin-13、Netrin-1降低是影响脑出血患者术后颅内感染的危险因素(P<0.05)。根据ROC曲线得知,血清Apelin-13预测脑出血患者术后颅内感染的曲线下面积(AUC)为0.849,血清Netrin-1预测脑出血患者术后颅内感染的AUC为0.853,二者联合预测脑出血患者术后颅内感染的AUC为0.876,二者联合的AUC优于各自单独预测(Z联合vs Apelin-13=2.123、Z联合vs Netrin-1=2.024,P均<0.05)。结论脑出血患者术后颅内感染的病原菌中革兰阳性菌占比高,且血清Apelin-1、Netrin-1水平显著降低,二者联合检测可以有效预测脑出血患者术后颅内感染。

Objective To investigate the distribution of pathogenic bacteria in postoperative intracranial infection in patients with intracerebral hemorrhage and the predictive value of serum angiotensin II receptor-like 13 receptor endogenous ligand 13 and neuro-directed factor(Netrin-1).Methods A total of 64 patients with cerebral hemorrhage who underwent craniotomy hematoma removal in our hospital from March 2019 to March 2023 were selected as the study subjects,and they were divided into infection group(14 cases)and non-infection group(50 cases)according to whether intracranial infection occurred after surgery.Identification of pathogenic bacteria using a fully automated immunoassay analyzer;Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of Apelin-13 and Netrin-1.Logistic regression analysis was used to analyze the influencing factors of intracranial infection in patients with intracerebral hemorrhage.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum Apelin-13 and Netrin-1 in patients with intracranial infection after intracranial hemorrhage.Results A total of 26 strains were isolated from 14 patients in the infection group,including 9 strains of gram-negative bacteria(34.62%),14 strains of gram-positive bacteria(53.85%),and 3 strains of fungi(11.54%).The differences in the patients'preoperative GCS scores,drain retention time,incisional subcutaneous fluid accumulation and prophylactic antibiotic use were statistically significant(P<0.05).Serum Apelin-1 and Netrin-1 levels were significantly lower in the infected group than in the non-infected group(P<0.05).Serum Apelin-13 and Netrin-1 levels were sequentially lower in the mild,moderate and severe groups(P<0.05).According to logistic regression analysis,it was known that decreased Apelin-13 and Netrin-1 were risk factors affecting postoperative intracranial infection in patients with cerebral haemorrhage(P<0.05).According to the receiver operating characteristic,the area under the curve(AUC)of serum Apelin-13 for predicting postoperative intracranial infection in patients with intracerebral hemorrhage was 0.849,and the AUC of serum Netrin-1 for predicting postoperative intracranial infection in patients with intracerebral hemorrhage was 0.853,the AUC of both methods for predicting postoperative intracranial infection in patients with intracerebral hemorrhage was 0.876,the AUC of both methods was better than that of their respective methods(Z_(combination vs Apelin-13)=2.123,Z_(combination vs Netrin-1)=2.024,P<0.05).Conclusion The pathogenic bacteria of postoperative intracranial infections in patients with cerebral haemorrhage have a high percentage of gram-positive bacteria and significantly lower serum Apelin-1 and Netrin-1 levels,and the combined detection of the two can effectively predict postoperative intracranial infections in patients with cerebral haemorrhage.