脑脊液、血清PCT联合检查对神经外科术后院内获得性颅内感染诊断价值的研究  

Diagnostic value of combined detection of cerebrospinal fluid and serum PCT for in-hospital acquired intracranial infection after neurosurgery

作　　者：王华军[1] 陈国忠 周成杰 姚丽娜 付晔 WANG Huajun;CHEN Guozhong;ZHOU Chengjie;YAO Li'na;FU Ye(Department of Critical Care Medicine,Yinzhou Hospital Affiliated to Ningbo University,Ningbo315040,China)

机构地区：[1]宁波大学附属鄞州医院重症医学科,浙江宁波315040

出　　处：《中国现代医生》2020年第6期5-8,I0001,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2018KY753)。

摘　　要：目的探讨脑脊液、血清降钙素原(PCT)差异对开颅患者颅内感染的诊断价值。方法收集我科2015年1月~2018年10月间开颅术后怀疑院内获得性颅内感染患者53例;最后确诊为颅内感染者20例设为研究组,排除颅内感染22例作为对照组,存在其他明确感染者11例被除外。分别比较两组血清、脑脊液PCT水平差异及脑脊液PCT阳性率;通过ROC曲线统计血清PCT、脑脊液PCT及脑脊液-血清PCT差值曲线下面积,并求得其诊断颅内感染最佳截点。结果研究组、对照组血清PCT分别为(0.11±0.03)ng/mL、(0.10±0.02)ng/mL,两组组间比较,差异无显著性(P>0.05);研究组脑脊液PCT为(0.14±0.03)ng/mL,高于对照组的(0.06±0.01)ng/mL,两组间比较差异有统计学意义(P<0.05);两组脑脊液-血清PCT差值分别为(0.04±0.01)ng/mL、(-0.05±0.01)ng/mL,两组间比较差异有统计学意义(P<0.05);脑脊液PCT、血清PCT、血清-脑脊液PCT差值ROC曲线下面积分别为0.91、0.52、0.80,三组间两两比较差异有统计学意义(P<0.05),脑脊液PCT诊断颅内感染最佳截点为0.08 ng/mL。结论提高脑脊液PCT截点或以脑脊液PCT≥血清PCT可用于开颅术后获得性颅内感染的诊断。Objective To investigate the diagnostic value of cerebrospinal fluid and serum procalcitonin(PCT)differences in intracranial infection in patients with craniotomy.Methods A total of 53 patients with suspected in-hospital acquired intracranial infection after craniotomy between January 2015 and October 2018 were enrolled.20 cases finally diagnosed with intracranial infection was set as the study group,and 22 cases of excluding intracranial infection were set as the control group,and 11 cases of other clearly infected cases were excluded.The differences of serum and cerebrospinal fluid PCT levels and positive rate of cerebrospinal fluid PCT were compared between the two groups.The area under the curve of serum PCT,cerebrospinal fluid PCT and cerebrospinal fluid-serum PCT difference was analyzed by ROC curve,and the best cut-off point for the diagnosis of intracranial infection was obtained.Results Serum PCT of the study group and the control group were(0.11±0.03)ng/mL and(0.10±0.02)ng/mL,respectively.There was no significant difference between the two groups(P>0.05).The PCT of the study group was(0.14±0.03)ng/mL,which was higher than(0.06±0.01)ng/mL of the control group.The difference between the two groups was statistically significant(P<0.05).The cerebrospinal fluid-serum PCT difference was(0.04±0.01)ng/mL,(-0.05±0.01)ng/mL,and the difference between the two groups was statistically significant(P<0.05).The area under the ROC curve of cerebrospinal fluid PCT,serum PCT,and serum-cerebrospinal fluid PCT difference were 0.91,0.52,and 0.80,respectively,and the difference between the three groups was statistically significant(P<0.05).The optimal cut-off point for cerebrospinal fluid PCT in diagnosis of intracranial infection was 0.08 ng/mL.Conclusion Increasing the cerebrospinal fluid PCT cut-off point or cerebrospinal fluid PCT greater than or equal to serum PCT can be used for the diagnosis of acquired intracranial infection after craniotomy.

关 键 词：颅内感染 降钙素原 血清 脑脊液 

分 类 号：R651.1[医药卫生—外科学]