脑脊液生化指标联合NGS检测诊断颅脑损伤患者术后颅内感染的价值研究  

Study on value of cerebrospinal fluid biochemical indicators combined with NGS on detecting and diagnosing postoperative intracranial infection in patients with craniocerebral injury

作　　者：杨超[1] 石柳 郑微 YANG Chao;SHI Liu;ZHENG Wei(Department of Neurosurgery,Meishan Hospital of Traditional Chinese Medicine,Chengdu University of Traditional Chinese Medicine,Meishan,Sichuan 620010,China;Department of Neurology,Meishan Hospital of Traditional Chinese Medicine,Chengdu University of Traditional Chinese Medicine,Meishan,Sichuan 620010,China)

机构地区：[1]成都中医药大学附属眉山医院,眉山市中医医院神经外科,四川眉山620010 [2]成都中医药大学附属眉山医院,眉山市中医医院神经内科,四川眉山620010

出　　处：《热带医学杂志》2024年第2期203-206,共4页Journal of Tropical Medicine

基　　金：四川省中医药管理局科学技术研究专项课题(2020JC0074)。

摘　　要：目的探究脑脊液生化指标联合二代测序技术(NGS)对颅脑损伤患者术后颅内感染的诊断价值。方法选取眉山市中医医院2019年1月-2021年3月期间颅脑损伤术后患者235例,按是否合并术后颅内感染分为颅内感染组19例和非颅内感染组216例,检测脑脊液C反应蛋白(CRP)、降钙素原(PCT)水平,病原体检测分别采用NGS和细菌培养,分析脑脊液生化指标联合NGS技术检测对颅脑损伤患者术后颅内感染的诊断价值。结果颅内感染组美国国立卫生研究院卒中量表(NIHSS)评分高于非颅内感染组,差异有统计学意义(t=7.166,P<0.05);颅内感染组脑脊液CRP、PCT水平均高于非颅内感染组,差异均有统计学意义(t=11.745、6.803,P均<0.05);NGS检测诊断颅脑损伤术后颅内感染阳性20例(8.51%),阴性215例(91.49%),其中真阳性16例(6.81%),真阴性212例(90.21%),Kappa值为0.804;19例颅内感染患者病原体主要为凝固酶阴性葡萄球菌(11/19,57.89%),其次为粪肠球菌(4/19,21.05%);受试者工作特征(ROC)曲线分析结果显示,脑脊液CRP、PCT水平以及NGS检测的曲线下面积(AUC)分别为0.904、0.915、0.912,敏感度分别为89.47%、89.50%、84.21%,特异度分别为81.02%、83.30%、98.15%,脑脊液CRP、PCT的cut-off值分别为42.12 mg/L、1.39 ng/L,联合诊断的AUC为0.986,高于各指标单一检测(P<0.05)。结论脑脊液生化指标联合NGS检测对颅脑损伤患者术后颅内感染具有一定的诊断价值,值得推广应用。Objective To explore the diagnostic value of cerebrospinal fluid biochemical indicators combined with next generation sequencing(NGS)on postoperative intracranial infection in patients with craniocerebral injury.Methods Patients with craniocerebral injury after surgery in the Meishan Hospital of Traditional Chinese Medicine from January 2019 to March 2021 were selected and divided into intracranial infection group(19 cases)and non⁃intracranial infection group(216 cases)according to whether the patients were complicated with postoperative intracranial infection.Cerebrospinal fluid C⁃reactive protein(CRP)and procalcitonin(PCT)levels were detected,and pathogens were detected by NGS and bacterial culture,respectively.The diagnostic value of cerebrospinal fluid biochemical indicators combined with NGS on postoperative intracranial infection in patients with craniocerebral injury was analyzed.Results National Institute of Health Stroke Scale(NIHSS)score in intracranial infection group was higher than that in non⁃intracranial infection group(t=7.166,P<0.05).The levels of CRP and PCT in cerebrospinal fluid in intracranial infection group were higher compared with those in non⁃intracranial infection group(t=11.745,6.803;all P<0.05).20 cases(8.51%)of intracranial infection after craniocerebral injury were positive and 215 cases(91.49%)were negative by NGS detection,of which 16 cases(6.81%)were true positive and 212 cases(90.21)were true negative,and the Kappa value of NGS in the diagnosis of intracreanial infection after craniocerebral injury was 0.804.The main pathogen of 19 patients with intracranial infection was coagulase negative staphylococcus(11/19,57.89%),followed by Enterococcus faecalis(4/19,21.05%).Receiver operating characteristic(ROC)curve analysis results showed that the area under the curve(AUC)of cerebrospinal fluid CRP,PCT and NGS were 0.904,0.915 and 0.912,and the sensitivities were 89.47%,89.50%and 84.21%,and the specificities were 81.02%,83.30%and 98.15%,respectively.The cut⁃off values of cere

关 键 词：颅脑损伤术后 颅内感染 二代测序技术 脑脊液 生化指标 

分 类 号：R651.15[医药卫生—外科学]