血清降钙素原在开颅术后颅内感染早期诊断中的价值  

The value of serum procalcitonin to early diagnosis of acute bacterial intracranial infection after craniotomy

作　　者：张洪微[1] 窦榕榕[1] 渠雪红[1] 范爱娥 李侠 

机构地区：[1]青岛大学附属医院神经外科,山东青岛266003 [2]青岛市中心医院神经外科,山东266042

出　　处：《中国临床神经外科杂志》2016年第12期756-758,761,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨血清降钙素原(PCT)在早期诊断开颅术后颅内感染中的应用价值。方法 2013年1月至2014年6月行择期开颅手术965例,术前1 d、术后3、7 d采集静脉血检测血清PCT、C反应蛋白(CRP),以及血常规进行白细胞计数。依据我国卫生部2001年发布的《医院感染诊断标准(试行)》做出颅内感染诊断,并全部得到细菌学检查确诊。结果 965中,确诊颅内感染64例(感染组),未发现颅内感染901例(无感染组)。感染组术后7 d血清PCT、血清CRP、外周血白细胞数量及心率均较术前明显升高(P<0.05)。非感染组术后7 d血清CRP和心率较术前明显升高(P<0.05),血清PCT和外周血白细胞数量较术前略有升高,但无统计学差异(P>0.05)。术后7 d,感染组血清PCT和外周血白细胞数量明显高于对照组(P<0.05),而血清CRT和心率与对照组无统计学差异(P>0.05)。术后7 d诊断开颅术后颅内感染的灵敏度和特异度:血清PCT分别为95.31%和91.23%;血清CRP分别为100%和59.93%;外周血白细胞数量分别为87.50%和67.04%;心率分别为85.94%和38.85%;血清PCT、血清CRP、外周血白细胞数量、心率的尤登指数分别为0.87、0.60、0.55、0.25。结论血清PCT在开颅术后早期诊断颅内感染的特异性和敏感性均较高,临床上可根据血清PCT的变化指导治疗及抗生素应用。Objective To evaluate the value of serum procalcitonin （PCT） to early diagnosis of acute bacterial intracranial infection after craniotomy. Methods Of 965 patients with intracranial lesions, who underwent craniotomy from January, 2013 to June, 2014, 64 had acute bacterial intracranial infection after the operation and 901 not. The level of serum PCT, blood C-reactive protein （CRP）, heart rate （HR） and white blood cell count （WBC） were determined 1 day before and 3 and 7 days after the craniotomy in all the patients, in whom the cerebrospinal fluid was taken by lumber puncture for bacterial culture 7 days after the craniotomy. Results The levels of serum PCT, blood CRP, HR and WBC were significantly higher 3 and 7 days after the craniotomy than those 1 day before the craniotomy in the infection group （P〈0.05）. The levels of CRP and HR were significantly higher 7 days after the craniotomy than those before the craniotomy in the non-infection group （P〈0.05）. The levels of serum PCT were significantly higher in the infection group than those in the non-infection group 3 and 7 days after the craniotomy （P〈0.05）.The level of WBC was significantly higher in the infection group than that in the non-infection group 7 days after the craniotomy （P〈0.05）. The sensitivity and specificity of serum level of PCT 〉 0.05 p~ g/L to the acute bacterial intracranial infection, which were 95.31% and 91.23% respectively, were significantly higher respectively than those of WBC and HR （P〈0.05）. The specificity of serum PCT to the acute bacterial intracranial infection was significantly higher than that of blood CRP （P〈0.05）. Conclusions The detection of level of serum PCT is helpful to the diagnosis and treatments of patients with acute bacterial intracranial infection after the craniotomy.

关 键 词：开颅手术 颅内感染 降钙素原 C反应蛋白 早期诊断 

分 类 号：R651.11[医药卫生—外科学]