基于Logistic回归分析颅脑手术后炎症指标动态变化及对颅内感染的诊断价值  

Dynamic changes of inflammatory indicators after cranial surgery and diagnostic value for intracranial infection:a Logistic regression analysis

作　　者：楚文强 彭俊祥[2] 李丹玲 CHU Wen-qiang;PENG Jun-xiang;LI Dan-ling(Department of Biostatistics,School of Public Health,Southern Medical University,Guangzhou 510515,China;Dept.of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学公共卫生学院生物统计学系,广东广州510515 [2]南方医科大学南方医院神经外科,广东广州510515

出　　处：《护理学报》2023年第1期22-27,共6页Journal of Nursing（China）

摘　　要：目的探究颅脑外科手术后患者体温、降钙素原、C反应蛋白、白细胞计数随时间的动态变化及其对颅内感染的诊断价值。方法分析1308例经手术治疗的颅内病变患者临床资料,根据是否发生感染分为感染组与非感染组,使用广义线性混合模型分析体温、C反应蛋白、白细胞计数及白细胞计数平均水平随时间的变化,使用Logistic回归对是否感染进行预测。结果(1)术后第1、第2、第3、第5、第7、第9天2组颅脑手术患者体温比较,差异均有统计学意义。术后2 d内2组患者白细胞计数、C反应蛋白、降钙素原均无差异,第3、第5、第7、第9天3项指标比较,差异均有统计学意义;(2)使用患者第2天体温、白细胞计数、C反应蛋白及降钙素原进行联合检测的AUC为0.802(95%CI:0.760~0.845),若增加第2天与第3天的差值来联合检测颅内感染可将AUC提高至为0.915(95%CI:0.887~0.949)。结论使用患者第2天各项指标及其与第3天指标的差值对感染进行预测可以大大提高预测准确性,提示临床应用中术后感染诊断时需要同时考虑生理指标及其变化趋势,可以有效提高神经外科术后患者的护理质量。Objective To investigate the dynamic changes over time of body temperature,procalcitonin,C-reactive protein and leukocyte count in patients after intracranial surgery and their diagnostic value for intracranial infections.Methods The clinical data of 1,308 patients with intracranial lesions treated by surgery were analyzed,and the patients were divided into infection group and non-infection group.The changes over time of body temperature,C-reactive protein,leukocyte count and mean level of leukocyte count were analyzed using generalized linear mixed model,and Logistic regression was used to predict the occurrence of infection.Results(1)The differences were statistically significant when comparing body temperature in the 2 groups on the 1st,2nd,3rd,5th,7th and 9th day after the surgery.There was no difference in leukocyte count,C-reactive protein and procalcitonin between the 2groups within 2 days after surgery,and the differences were statistically significant when comparing these three indexes on the 3rd,5th,7th and 9th day after the surgery.(2)The AUC of the combined test of body temperature,leukocyte count,C-reactive protein and procalcitonin on the 2nd day was 0.802(95%CI:0.760 to 0.845),and the AUC could be increased to 0.915(95%CI:0.887 to 0.949)when the difference of the indicators between the 2nd and 3rd day were included.Conclusion The prediction accuracy can be greatly improved when the indicators and the difference of the indicators between day 2 and 3 are used for the prediction of intracranial infection,suggesting the necessity of considering both physiological indicators and their trends when diagnosing postoperative infection in clinical practice,which can also effectively improve the nursing quality of neurosurgical patients.

关 键 词：颅内感染 白细胞计数 降钙素原 C反应蛋白 预测模型 

分 类 号：R473.6[医药卫生—护理学] R651.1[医药卫生—临床医学]