神经元特异性烯醇化酶、血管紧张素Ⅱ与丙二醛在颅内感染的诊疗价值

Diagnostic and therapeutic value of neuron-specific enolase,angiotensinⅡ,and malondialdehyde in intracranial infections

目的探讨神经元特异性烯醇化酶(neuron specific enolase,NSE)、血管紧张素Ⅱ(angiotensinⅡ,Ang-Ⅱ)与丙二醛(Malondialdehyde,MDA)检测在脑出血开颅术后颅内感染的诊疗价值。方法回顾性分析95例脑出血开颅术病例资料,根据术后1周内是否出现颅内感染分为感染组(n=35)与未感染组(n=60),比较两组基线资料,生化指标:白细胞计数(white blood cell count,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、白蛋白(albumin,ALB),实验室指标(NSE、Ang-Ⅱ、MDA)。采用Logistic多因素回归,分析影响脑出血开颅术后颅内感染的危险因素。采用受试者工作特征曲线(receiver operating characteristic,ROC),分析NSE、Ang-Ⅱ、MDA诊断脑出血开颅术后颅内感染的效能。感染组病人均接受鞘内注射药物治疗,治疗3 d后依据临床体征分为感染控制组(n=25)与感染未控制组(n=10),分别于治疗后3d、7d、14d检测病人NSE,Ang-Ⅱ,MDA水平。结果与未感染组比较,感染组合并糖尿病率、术后凝血功能障碍发生率及PCT、ALB、NSE、Ang-Ⅱ、MDA水平均较高(P<0.05)。Logistic多因素回归分析结果显示:合并糖尿病(OR=1.812,95%CI:1.505~2.515)、术后凝血功能障碍(OR=1.856,95%CI:1.512~2.526)、PCT水平高(OR=1.850,95%CI:1.519~2.494)、NSE水平高(OR=1.824,95%CI:1.537~2.638)、Ang-Ⅱ水平高(OR=1.885,95%CI:1.584~2.649)、MDA水平高(OR=1.964,95%CI:1.558~2.715)是影响脑出血开颅术后颅内感染的独立危险因素。NSE、Ang-Ⅱ、MDA三者联合诊断脑出血开颅术后颅内感染的AUC为0.912(95%CI:0.740~0.948)。治疗后14d,NSE、Ang-Ⅱ、MDA动态变化显示,感染控制组治疗后3d、7d、14d NSE、Ang-Ⅱ、MDA水平均低于感染未控制组(P<0.05)。结论NSE、Ang-Ⅱ、MDA三者联合检测,可提高对脑出血开颅术后感染的诊断价值与疗效评估价值。

Objective To investigate the diagnostic and therapeutic value of neuron-specific enolase(NSE),angiotensinⅡ(Ang-Ⅱ),and malondialdehyde(MDA)in intracranial infections after craniotomy for cerebral hemorrhage.Methods The clinical data of 95 patients undergoing craniotomy for cerebral hemorrhage were retrospectively analyzed.The patients were divided into infection group(n=35)and non-infection group(n=60)based on whether intracranial infection occurred within one week after surgery.The baseline data,biochemical indicators including white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),and albumin(ALB),and laboratory indicators(NSE,Ang-Ⅱ,MDA)were compared between the two groups.Logistic multivariate regression analysis was used to analyze the risk factors for intracranial infection after craniotomy for cerebral hemorrhage.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of NSE,Ang-Ⅱ,and MDA in intracranial infections after craniotomy for cerebral hemorrhage.All the patients in the infection group received intrathecal drug therapy,and were divided into infection-controlled group(n=25)and infection-uncontrolled group(n=10)based on clinical signs after 3 days of treatment.The levels of NSE,Ang-Ⅱ,and MDA were measured at 3,7,and 14 d after treatment.Results Compared with the non-infection group,the infection group had a higher incidence of diabetes mellitus and postoperative coagulation dysfunction,and higher levels of PCT,ALB,NSE,Ang-Ⅱand MDA(P<0.05).Logistic multivariate regression analysis showed that diabetes mellitus(OR=1.812,95%CI:1.505-2.515),postoperative coagulation dysfunction(OR=1.856,95%CI:1.512-2.526),high PCT level(OR=1.850,95%CI:1.519-2.494),high NSE level(OR=1.824,95%CI:1.537-2.638),high Ang-Ⅱlevel(OR=1.885,95%CI:1.584-2.649),and high MDA level(OR=1.964,95%CI:1.558-2.715)were independent risk factors for intracranial infection after craniotomy for cerebral hemorrhage.The AUC for the combined diagnosis of intracranial infection after craniotomy for cerebral hemorrhage with NSE,Ang-Ⅱ,and MDA was 0.912(95%CI:0.740-0.948).Dynamic changes in NSE,Ang-Ⅱ,and MDA levels at 14 d after treatment showed that the levels of NSE,Ang-Ⅱ,and MDA in the infection-controlled group were lower than those in the infection-uncontrolled group at 3,7,and 14 d after treatment(P<0.05).Conclusion The combined detection of NSE,Ang-Ⅱ,and MDA can improve the diagnostic value and therapeutic efficacy evaluation for intracranial infection after craniotomy for cerebral hemorrhage.