脑脊液Presepsin、sTREM-1水平与颅脑术后继发颅内感染患者病情严重程度及预后关系研究

Study on the relationship between cerebrospinal fluid Presepsin and sTREM-1 levels and the severity and prognosis of patients with secondary intracranial infection after craniocerebral surgery

目的 分析颅脑术后继发颅内感染患者脑脊液可溶性白细胞分化抗原14亚型(Presepsin)和可溶性髓系细胞触发受体-1(sTREM-1)表达水平与病情严重程度及预后的关系。方法 选取贵阳市第二人民医院神经外科2019年4月-2023年4月收治的246例接受颅脑手术患者,根据术后1个月内是否继发颅内感染分为感染组和未感染组,经过抗感染治疗后,分为治愈组和未治愈组;采用酶联免疫吸附测定(ELISA)法检测脑脊液Presepsin和sTREM-1表达水平;采用Spearman相关分析脑脊液Presepsin和sTREM-1表达水平与格拉斯哥昏迷评分(GCS)评分的相关性;采用Logistic回归分析影响继发颅内感染患者预后的因素;采用受试者工作特征(ROC)曲线分析脑脊液Presepsin和sTREM-1对继发颅内感染患者预后的预测价值。结果 感染组与未感染组GCS评分、术后临床症状、白细胞计数(WBC)、乳酸(Lac)、C反应蛋白(CRP)之间比较差异有统计学意义(P<0.05);与未感染组相比,感染组脑脊液Presepsin和sTREM-1表达水平显著升高,差异有统计学意义(P<0.05);Spearman相关分析结果显示,脑脊液Presepsin和sTREM-1表达水平与GCS评分呈负相关(r=-0.696,P <0.001;r=-0.658,P <0.001);治愈组与未治愈组相比,CRP、Presepsin、sTREM-1之间比较差异有统计学意义(P<0.05);Logistic回归分析结果显示,CRP、Presepsin、sTREM-1是术后颅内感染患者预后的影响因素(P<0.05);ROC曲线分析结果显示,脑脊液Presepsin和sTREM-1表达水平联合预测术后颅内感染患者预后的价值较单一指标价值更高(P<0.05)。结论 颅脑术后继发颅内感染患者脑脊液Presepsin和sTREM-1表达水平显著升高,且与患者病情严重程度相关,两者可作为术后继发颅内感染患者预后预测的生物学指标。

Objective To analyze the relationship between the expression levels of Presepsin and soluble triggering receptor expressed on myeloid cell-1(sTREM-1)in cerebrospinal fluid of patients with secondary intracranial infection after craniocerebral surgery and the severity and prognosis of the condition.Methods A total of 246 patients who underwent craniocerebral surgery in the Department of Neurosurgery of the Guiyang Second People's Hospital from April 2019 to April 2023 were selected.They were grouped into an infected group and an uninfected group based on whether there was a secondary intracranial infection within one month after surgery.After anti infection treatment,they were grouped into a cured group and an uncured group;enzyme linked immunosorbent assay(ELISA)was applied to detect the expression levels of Presensin and sTREM-1 in cerebrospinal fluid;Spearman correlation was applied to analyze the correlation between the expression levels of Presepsin and sTREM-1 in cerebrospinal fluid and the Glasgow Coma Scale(GCS)score;Logistic regression was applied to analyze the factors affecting the prognosis of patients with secondary intracranial infections;receiver operating characteristic(ROC)curve was applied to analyze the predictive value of cerebrospinal fluid Presepsin and sTREM-1 for the prognosis of patients with secondary intracranial infections.Results There was a statistically obvious difference in GCS score,postoperative clinical symptoms,white blood cell count(WBC),lactate(Lac),and C-reactive protein(CRP)between the infected and uninfected groups(P<0.05);compared with the uninfected group,the expression levels of Presepsin and sTREM-1 in the cerebrospinal fluid of the infected group were obviously increased(P<0.05);Spearman correlation analysis showed that the expression levels of Presepsin and sTREM-1 in cerebrospinal fluid were negatively correlated with GCS score(r=-0.696,P<0.001;r=-0.658,P<0.001);there was a statistically obvious difference in CRP,Presepsin,and sTREM-1 between cured group and untreated group(P<0.05);the results of Logistic regression analysis showed that CRP,Presepsin,and sTREM-1 were influencing factors for the prognosis of postoperative intracranial infection patients(P<0.05);the results of receiver operating characteristic analysis showed that the expression levels of preseptin and sTREM-1 in cerebrospinal fluid was more valuable than a single index in predicting the prognosis of patients with intracranial infection after surgery(P<0.05).Conclusion The expression levels of Presepsin and sTREM-1 in cerebrospinal fluid of patients with secondary intracranial infection after craniocerebral surgery are obviously increased,and are correlated with the severity of condition.The two can serve as biological indicators for predicting the prognosis of patients with secondary intracranial infection after surgery.