脑室外引流术后患者颅内感染影响因素及脑脊液NF⁃κB、PCT、IL⁃1β预测价值

Influencing factors of intracranial infection and predictive value of NF⁃κB,PCT and IL⁃1βin cerebrospinal fluid after external ventricular drainage

目的探究脑室外引流(EVD)术后患者颅内感染影响因素及脑脊液NF⁃κB、PCT、IL⁃1β预测价值。方法选取2021年11月至2023年11月期间南宁市第二人民医院收治的EVD术后患者227例,根据术后颅内感染情况,分为感染组(n=30)例与非感染组(n=197)。收集并比较两组患者相关临床资料及实验室指标,采用多因素Logistic分析EVD术后患者颅内感染的危险因素,并以受试者工作特性曲线(ROC)分析脑脊液核因子⁃κB(NF⁃κB)、降钙素原(PCT)、白细胞介素(IL)⁃1β对EVD术后患者颅内感染的预测效能。结果两组在(重症加强护理病房)ICU治疗时间、是否出现休克、是否合并低蛋白血症、脑室外引流时长、脑脊液NF⁃κB、PCT以及IL⁃1β水平上的比较,差异均具有统计学意义(χ^(2)/t=4.589,8.841,18.604,4.601,4.421,6.314,4.746,P<0.05)。多因素Logistic回归分析显示,低蛋白血症、脑室外引流时长>7 d以及脑脊液NF⁃κB、PCT、IL⁃1β表达水平升高均为EVD术后患者颅内感染的独立危险因素(OR=2.298,2.197,2.179,1.893,1.978,P<0.05)。脑脊液NF⁃κB、PCT、IL⁃1β以及三者联合检测的ROC面积分别为0.718、0.753、0.726以及0.870(P<0.05)。结论脑脊液NF⁃κB、PCT、IL⁃1β表达水平的紊乱均为EVD术后颅内感染的高危影响因素,且三者联合检测对EVD术后颅内感染的预测价值较高。

Objective To explore the influencing factors of intracranial infection and the predictive value of NF⁃κB,PCT and IL⁃1βin cerebrospinal fluid after EVD.Methods A total of 227 EVD postoperative patients admitted to the Second People's Hospital of Nanning from November 2021 to November 2023 were se⁃lected and divided into two groups:an infected group(n=30)and a non⁃infected group(n=197)based on post⁃operative intracranial infection.Relevant clinical data and laboratory indicators were collected and compared be⁃tween the two groups,and the risk factors of intracranial infection after EVD were analyzed by multivariate lo⁃gistic analysis.The predictive efficacy of cerebrospinal fluid nuclear factor⁃κB(NF⁃κB),procalcitonin(PCT)and interleukin(IL)1βon intracranial infection after EVD was analyzed using receiver operating characteristic curve(ROC).Results There were statistically significant differences between the two groups in ICU treatment time,occurrence of shock,presence of hypoproteinemia,duration of extraventricular drainage,levels of NF⁃κB,PCT and IL⁃1βin cerebrospinal fluid(χ^(2)/t=4.589,8.841,18.604,4.601,4.421,6.314,4.746,P<0.05)Multivariate logistic regression analysis showed that hypoproteinemia,external ventricular drainage duration>7 days and increased expression levels of NF⁃κB,PCT and IL⁃1βin cerebrospinal fluid were independent risk fac⁃tors for intracranial infection after EVD(OR=2.298,2.197,2.179,1.893,1.978),(P<0.05).The ROC areas for NF⁃κB,PCT,IL⁃1βand their combined detection were 0.718,0.753,0.726 and 0.870,respectively(P<0.05).Conclusion The disturbance in the expression levels of NF⁃κB,PCT,and IL⁃1βin cerebrospinal fluid is a significant risk factor for intracranial infection following EVD.The combined detection of these three factors has a high predictive value for intracranial infection after EVD.