颅内感染性动脉瘤病原学及其危险因素  

Etiological characteristics and risk factors for intracranial infectiouss aneurysms

作　　者：周鑫宇 沈延艳[1] 胡新[1] 曹毅男 纪叶 韩宇飞 ZHOU Xin-yu;SHEN Yan-yan;HU Xin;CAO Yi-nan;JI Ye;HAN Yu-fei(Shengjing Hospital of China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院第一神经外科,辽宁沈阳110004

出　　处：《中华医院感染学杂志》2023年第15期2305-2309,共5页Chinese Journal of Nosocomiology

基　　金：辽宁省自然科学基金资助项目(2020927)。

摘　　要：目的 分析颅内感染性动脉瘤患者病原菌分布及危险因素。方法 回顾性分析中国医科大学附属盛京医院2017年7月-2020年7月收治的74例颅内动脉瘤患者的临床资料,按颅内动脉瘤类型,将14例颅内感染性动脉瘤患者定义为感染组,将非感染性颅内动脉瘤60例患者定义为非感染组,运用多因素Logistic回归分析法分析颅内感染性动脉瘤发生的危险因素,并分析感染组基质金属蛋白酶表达变化和脑脊液中病原菌的分布。结果 感染组Hunt-Hess分级中3~4级、动脉瘤大小中大型动脉瘤及糖尿病例数占比均高于非感染组(P<0.05);感染组病原菌分布中以革兰阳性菌为主(12株),其中草绿色链球菌属和金黄色葡萄球菌分别为6、3株;感染组基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶-2(MMP-2)和血管内皮细胞生长因子(VEGF)水平均高于非感染组(P<0.05);危险因素分析中,Hunt-Hess分级、动脉瘤大小、糖尿病、感染性心内膜炎及血清C-反应蛋白(CRP)、降钙素原(PCT)和MMP-9、MMP-2、VEGF水平异常升高均与颅内感染性动脉瘤发生相关(P<0.05)。结论 颅内感染性动脉瘤病原感染以革兰阳性菌为主,血清CRP、PCT、MMP-9、MMP-2和VEGF异常升高及糖尿病、感染性心内膜炎等为颅内感染性动脉瘤发生的独立危险因素。OBJECTIVE To analyze the pathogenic bacteria distribution and risk factors for intracranial infectious aneurysms.METHODS A retrospective analysis was performed on the clinical data of 74 patients with intracranial aneurysms in Shengjing Hospital of China Medical University between Jul 2017 and Jul 2020.According to the types of intracranial aneurysms,14 patients with intracranial infectious aneurysms were defined as the infected group,and 60 patients with non-infectious intracranial aneurysms were as the non-infected group.Multivariate logistic regression analysis was used to analyze the risk factors for intracranial infectious aneurysms,and the change of matrix metalloproteinases expression and distribution of pathogenic bacteria in cerebrospinal fluid of infected group were analyzed.RESULTS The proportions of Hunt-Hess grade 3-4,large aneurysms and diabetes in the infected group were higher than those in the non-infected group(P<o.05).The distribution of pathogenic bacteria in the infected group was mainly gram-positive bacteria(12 strains),including 6 strains of Streptococcus viridans and 3 strains of Staphylococcus aureus.The levels of matrix metalloproteinase-9(MMP-9),matrix metalloproteinase-2(MMP-2)and vascular endothelial growth factor(VEGF)in the infected group were higher than those in the non-infected group(P<0.05).Factors including Hunt-Hess grade,aneurysm size,the number of cases with diabetes mellitus,infectious endocarditis and abnormal increases of serum C-reactive protein(CRP),procalcitonin(PCT),MMP-9,MMP-2 and VEGF were all related to the occurrence of intracranial infectious aneurysms(P<O.05).CONCLUSION The pathogenic infection of intracranial infectious aneurysms is mainly Gram-positive bacteria,and the abnormal increases of serum CRP,PCT,MMP-9,MMP-2 and VEGF,diabetes mellitus and infectious endocarditis are independent risk factors for ntracranial infectious aneurysm.

关 键 词：颅内感染性动脉瘤 基质金属蛋白酶 病原菌 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]