脑脊液降钙素原对开颅术后细菌性脑膜炎的早期诊断价值

Early diagnostic value of cerebrospinal fluids procalcitonin for the post-neurosurgery bacterial meningitis

目的 探讨检测脑脊液降钙素原(PCT)对开颅术后细菌性脑膜炎(PNBM)患者的早期诊断价值.方法 选取我院ICU收治的怀疑为PNBM的34例患者作为研究对象进行前瞻性研究.入组当天采集外周静脉血行血常规、C反应蛋白、PCT检测.留取脑脊液行常规、生化、PCT检测及脑脊液培养.根据PNBM诊断标准将患者分为PNBM(感染组)与非PNBM(非感染组).结果 15例(44.12％)患者(感染组)符合PNBM诊断标准,余19例为非感染组.在怀疑感染当天感染组患者脑脊液PCT浓度(中位数为0.50 μg/L)明显高于非感染组(中位数为0.29μg/L),差异有统计学意义(P均＜0.01).ROC曲线分析显示:脑脊液PCT曲线下面积为0.846,高于其他传统指标曲线下面积,脑脊液PCT理想的最佳诊断PNBM的水平为0.42 μg/L,该临界值的敏感度为80.0％,特异性为73.7％.结论 脑脊液PCT诊断PNBM的敏感度和特异性均优于其他传统指标,脑脊液PCT对早期PNBM具有很好的诊断价值.

Objective To evaluate the early diagnostic value of cerebrospinal fluids (CSF) procalcitonin(PCT) for the post-neurosurgery bacterial meningitis (PNBM).Methods Conduct a prospective study in 34 patients who suspected PNBM in ICU of Kowloon Hospital of Suzhou.On the first day, all the patient blood samples were obtained for detection of routine blood count, C-reactive protein, PCT.Also, all the patient CSF samples were obtained for detection of routine CSF count, biochemical tests, PCT and for CSF culture.The patients were divided into PNBM group and non-PNBM group according to PNBM diagnostic criteria.Results Fifteen cases(44.12％) patients were diagnosed as PNBM,the other 19 cases were non infection group.Levels of CSF procalcitonin PCT 0.50 μg/L were significantly higher in patients with PNBM than those non-PNBM 0.29 μg/L on the first day(P＜0.01).The ROC curues indicated that the area under the curve (AUC) for CSF PCT was 0.846, it was significantly higher than the other traditional indicators' area.The cut off points of CSF procalcitonin was set to be 0.415 μg/L for patients with proven PNBM.The corresponding sensitivity, sepecificity were 80.0％ and 73.7％.Conclusion The level of the CSF procalcitonin may be valuable early diagnostic parameter for PNBM.Sensitivity and specificity of the CSF procalcitonin was higher than the other traditional indicators.