神经外科术后脑脊液PCT影响因素及价值研究  

Influencing factors and value of cerebrospinal fluid PCT after neurosurgery

作　　者：王华军[1] 付晔 周成杰 欧阳礼枝 WANG Huajun;FU Ye;ZHOU Chengjie;OUYANG Lizhi(Department of Critical Care Medicine,Affiliated People’s Hospital of Ningbo University,Ningbo 315040,Zhejiang,China)

机构地区：[1]宁波大学附属人民医院重症医学科,浙江宁波315040

出　　处：《中国现代医生》2023年第30期15-19,共5页China Modern Doctor

基　　金：浙江省宁波市医学科技计划项目(2020Y44);浙江省医药卫生科技计划项目(2022KY1183)。

摘　　要：目的探讨神经外科术后脑脊液降钙素原(procalcitonin,PCT)的影响因素及临床价值。方法收集2021年1月至2022年5月宁波大学附属人民医院神经外科术后所有怀疑颅内感染患者腰椎穿刺或脑室引流的脑脊液及血清样本。Logistic多因素分析神经外科术后脑脊液PCT升高的影响因素。所有研究对象根据颅内感染诊断标准分为颅内感染组和无菌性脑膜炎组。非参数检验比较颅内感染组和无菌性脑膜炎组各指标差异。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价各指标对颅内感染的诊断效能。结果本研究共入组139例患者,其中109例患者脑脊液PCT升高(78.4%),其中颅内感染患者59例(54.1%),无菌性脑膜炎患者50例(45.9%)。Logistic多因素分析结果表明,颅内感染和血性脑脊液是神经外科术后脑脊液PCT增高的独立危险因素;颅内感染组与无菌性脑膜炎组的脑脊液PCT和血清PCT水平差异无统计学意义。两组患者的脑脊液乳酸水平和脑脊液PCT/血清PCT差异有统计学意义。脑脊液PCT、血清PCT、脑脊液乳酸、脑脊液PCT/血清PCT、脑脊液PCT和乳酸联合诊断ROC曲线下面积分别为0.56、0.58、0.82、0.85、0.83。结论颅内感染和血性脑脊液是神经外科术后脑脊液PCT升高的独立因素。单纯以脑脊液PCT增高诊断神经外科术后颅内感染价值有限,需通过联合其他指标提高诊断效能。Objective To explore the influence factors and clinical value of postoperative procalcitonin(PCT)in cerebrospinal fluidamong patients after neurosurgery.Methods Cerebrospinal fluid and serum samples were collected from patients had been suspected of intracranial infection after craniotomy in Affiliated People’s Hospital of Ningbo University from January 2021 to May 2022 by lumbar puncture or ventricular drainage tube.Logistics multivariate analysis was performed to identify factors associated with elevated cerebrospinal fluid PCT levels after neurosurgery.Based on the diagnostic criteria for intracranial infection,the study subjects were divided into two groups:The intracranial infection group and the aseptic meningitis group.Nonparametric test was conducted to compare the differences in various indicators between the intracranial infection group and the aseptic meningitis group.The diagnostic efficacy of each index was assessed using receiver operating characteristic(ROC)curve.Results A total of 139 cases of cerebrospinal fluidwere collected in this study,109 cases of cerebrospinal fluid PCT increased(78.4%),including 59 cases of intracranial infection(54.1%),50 cases of aseptic meningitis(45.9%).Logistics multivariate analysis showed that intracranial infection and bloody cerebrospinal fluidwere the influencing factors for the increase of cerebrospinal fluid PCT.There was no statistically significant difference in cerebrospinal fluid PCT and serum PCT levels between the intracranial infection group and the aseptic meningitis group.Significant differences were observed in cerebrospinal fluid lactate levels and cerebrospinal fluid PCT/serum PCT ratio between the two groups.The area under the ROC of cerebrospinal fluid PCT,serum PCT,cerebrospinal fluidlactate,cerebrospinal fluid PCT/serum PCT,cerebrospinal fluid PCT and lactatewere 0.56,0.58,0.82,0.85,0.83,respectively.Conclusion Intracranial infection and bloody cerebrospinal fluid are independent factors for the elevation of cerebrospinal fluid PCT after neuro

关 键 词：颅内感染 降钙素原 血清 脑脊液 乳酸 影响因素 神经外科术后 

分 类 号：R63[医药卫生—外科学]