脑脊液乳酸、白细胞介素-27及干扰素-γ联合检测在神经外科术后细菌性脑膜炎中的诊断价值  

Value of combined detection of cerebrospinal fluid lactate,interleukin-27 and interferon-γin diagnosing bacterial meningitis after neurosurgical operation

作　　者：曾东[1] 孙雯雯 陈光辉 王真珍 ZENG Dong;SUN Wenwen;CHEN Guanghui;WANG Zhenzhen(Intensive Care Unit,the Seventh People′s Hospital of Zhengzhou City in Henan Province,Zhengzhou,Henan,450000)

机构地区：[1]河南省郑州市第七人民医院重症医学科,河南郑州450000

出　　处：《实用临床医药杂志》2024年第2期23-27,共5页Journal of Clinical Medicine in Practice

基　　金：2022年度河南省医学科技攻关计划联合共建项目(LHGJ20220847)。

摘　　要：目的探讨脑脊液乳酸(LA)、白细胞介素-27(IL-27)及干扰素-γ(IFN-γ)联合检测对重症监护室(ICU)神经外科术后细菌性脑膜炎的诊断价值。方法选取ICU神经外科术后细菌性脑膜炎患者54例作为疾病组,另选取62例术后无细菌性脑膜炎患者作为对照组。采用全自动生化分析仪和酶联免疫吸附法(ELISA)检测脑脊液LA、IL-27、IFN-γ表达水平;采用Logistic回归模型分析影响术后发生细菌性脑膜炎的相关因素;采用受试者工作特征(ROC)曲线分析脑脊液LA、IL-27、IFN-γ对术后细菌性脑膜炎的诊断价值。结果疾病组葡萄糖水平低于对照组,白细胞计数、蛋白质水平高于对照组,差异均有统计学意义(P<0.01)。疾病组脑脊液LA、IL-27表达水平高于对照组,而脑脊液IFN-γ表达水平低于对照组,差异均有统计学意义(P<0.01)。Logistic回归分析显示,脑脊液LA、IL-27、IFN-γ为ICU神经外科术后患者发生细菌性脑膜炎的影响因素(P<0.05)。脑脊液LA、IL-27、IFN-γ联合诊断ICU神经外科术后细菌性脑膜炎的曲线下面积(AUC)为0.955,优于脑脊液LA(AUC=0.806,Z=4.029,P<0.001)、IL-27(AUC=0.858,Z=2.513,P=0.012)、IFN-γ(AUC=0.815,Z=3.680,P<0.001)单独诊断,联合诊断的灵敏度和特异度分别为87.04%、93.55%。结论ICU神经外科术后细菌性脑膜炎患者脑脊液LA、IL-27表达水平均显著升高,而脑脊液IFN-γ水平显著较低。相较于单独检测,3项指标联合检测对术后发生细菌性脑膜炎有更高的诊断价值。Objective To explore the value of combined detection of cerebrospinal fluid lactate(LA),interleukin-27(IL-27)and interferon-γ(IFN-γ)in diagnosing bacterial meningitis after neurosurgical operation in Intensive Care Unit(ICU).Methods A total of 54 patients with bacterial meningitis after neurosurgical operation in ICU were collected as disease group,and 62 patients without bacterial meningitis after operation were collected as control group.Fully automated biochemical analyzer and enzyme-linked immunosorbent assay(ELISA)were used to detect the expression levels of LA,IL-27 and IFN-γin cerebrospinal fluid;the Logistic regression model was used to analyze the related factors affecting bacterial meningitis after operation;the receiver operating characteristic(ROC)curve was used to analyze the diagnostic values of LA,IL-27 and IFN-γin cerebrospinal fluid for bacterial meningitis after operation.Results The glucose level in the disease group was significantly lower than that in the control group,while the white blood cell count and protein level were significantly higher than those in the control group(P<0.01).The expression levels of LA and IL-27 in the cerebrospinal fluid in the disease group were significantly higher than those in the control group,while IFN-γlevel in the cerebrospinal fluid was significantly lower than that in the control group(P<0.01).Logistic regression analysis showed that LA,IL-27 and IFN-γin the cerebrospinal fluid were the influencing factors of bacterial meningitis after neurosurgical operation in ICU(P<0.05).The area under the curve(AUC)of LA combined with IL-27 and IFN-γin cerebrospinal fluid in the diagnosis of bacterial meningitis after neurosurgical operation in ICU was 0.955,which was better than that of single diagnosis based on LA(AUC=0.806,Z=4.029,P<0.001),IL-27(AUC=0.858,Z=2.513,P=0.012)and IFN-γ(AUC=0.815,Z=3.680,P<0.001)in cerebrospinal fluid,and the sensitivity and specificity of the combined diagnosis were 87.04%and 93.55%respectively.Conclusion The expression levels of

关 键 词：脑脊液 乳酸 白细胞介素-27 干扰素-Γ 细菌性脑膜炎 

分 类 号：R515.2[医药卫生—内科学] R322.81[医药卫生—临床医学] R446.11