开颅术后颅内感染患者脑脊液促炎性细胞因子及血脑屏障破坏程度与预后的关系分析

Analysis of Relationship between Cerebrospinal Fluid Proinflammatory Cytokine and Blood-brain Barrier Disruption Degree and Prognosis in Patients with Intracranial Infection after Craniotomy

目的:分析开颅术后颅内感染患者脑脊液促炎性细胞因子及血脑屏障破坏程度与预后的关系。方法:回顾性分析2019年6月—2023年6月于宜春市人民医院实施开颅术后发生颅内感染的60例患者的临床资料。所有患者均检测脑脊液促炎性细胞因子[高迁移率族蛋白B-1(HMGB-1)、巨噬细胞炎症蛋白-1α(MIP-1α)、γ干扰素(IFN-γ)、白细胞介素-6(IL-6)]和血脑屏障破坏程度[脑脊液白蛋白/血清白蛋白比值]。根据预后情况[格拉斯哥昏迷量表(GCS)评分]将患者分为预后良好组(GCS评分>8分,n=24)和预后不良组(GCS评分≤8分,n=36),比较两组脑脊液HMGB-1、MIP-1α、IFN-γ、IL-6水平和脑脊液白蛋白/血清白蛋白比值,使用Pearson相关系数分析脑脊液促炎性细胞因子、血脑屏障破坏程度与预后的相关性。以受试者操作特征(ROC)曲线分析脑脊液促炎性细胞因子联合血脑屏障破坏程度预测开颅术后颅内感染患者预后情况的价值。结果:预后不良组脑脊液HMGB-1、MIP-1α、IFN-γ、IL-6水平和脑脊液白蛋白/血清白蛋白比值均显著高于预后良好组,差异均有统计学意义(P<0.05)。Pearson相关系数分析结果显示,脑脊液HMGB-1、MIP-1α、IFN-γ、IL-6水平和脑脊液白蛋白/血清白蛋白比值与开颅术后颅内感染患者GCS评分均呈负相关(P<0.05)。ROC曲线中,脑脊液HMGB-1、MIP-1α、IFN-γ、IL-6水平联合脑脊液白蛋白/血清白蛋白比值预测开颅术后颅内感染患者预后情况的曲线下面积(AUC)为0.977,敏感度为94.44%,特异度为92.50%。结论:开颅术后颅内感染患者脑脊液促炎性细胞因子及血脑屏障破坏程度与预后密切相关,临床可通过检测其水平,预测患者预后。

Objective:To analyze the relationship between cerebrospinal fluid proinflammatory cytokine and blood-brain barrier destruction degree and prognosis in patients with intracranial infection after craniotomy.Method:The clinical data of 60 patients with intracranial infection after craniotomy in Yichun People's Hospital from June 2019 to June 2023 were retrospectively analyzed.Cerebrospinal fluid proinflammatory cytokine[high mobility group protein B-1(HMGB-1),macrophage inflammatory protein-1α(MIP-1α),γinterferon(IFN-γ),interleukin-6(IL-6)]and blood-brain barrier destruction degree[cerebrospinal fluid albumin/serum albumin ratio]were measured in all patients.According to the prognosis[Glasgow coma scale(GCS)score],the patients were divided into good prognosis group(GCS score>8 points,n=24)and poor prognosis group(GCS score≤8 points,n=36).The levels of HMGB-1,MIP-1α,IFN-γ,IL-6 and the cerebrospinal fluid albumin/serum albumin ratio were compared between the two groups.Pearson correlation coefficient was used to analyze the correlation between cerebrospinal fluid proinflammatory cytokine,blood-brain barrier destruction degree and prognosis.Receiver operator characteristic(ROC)curve was used to analyze the value of cerebrospinal fluid proinflammatory cytokine combined with blood-brain barrier destruction degree in predicting the prognosis of patients with intracranial infection after craniotomy.Result:The levels of HMGB-1,MIP-1α,IFN-γ,IL-6 and the cerebrospinal fluid albumin/serum albumin ratio in the poor prognosis group were significantly higher than those in the good prognosis group,the differences were statistically significant(P<0.05).The results of Pearson correlation coefficient analysis showed that the levels of HMGB-1,MIP-1α,IFN-γ,IL-6 and the cerebrospinal fluid albumin/serum albumin ratio were negatively correlated with the GCS scores of patients with intracranial infection after craniotomy(P<0.05).In ROC curve,the area under the curve(AUC)of HMGB-1,MIP-1α,IFN-γand IL-6 combined with cerebrospinal fluid albumin/serum albumin ratio predicted the prognosis of patients with intracranial infection after craniotomy was 0.977,the sensitivity was 94.44%,and the specificity was 92.50%.Conclusion:In patients with intracranial infection after craniotomy,the cerebrospinal fluid proinflammatory cytokine and blood-brain barrier destruction degree is closely related to the prognosis,the prognosis of patients can be predicted by detecting their levels clinically.