外伤性脑出血患者术后感染病原菌分布特点及血清PCT和SAA变化的意义  

Distribution characteristics of postoperative infection pathogens in patients with traumatic intracerebral hemorrhage and significance of the changes of serum PCT and SAA

作　　者：刘红娜[1] 陈兴河[1] 华红果[1] 王娜[1] 吴丹 LIU Hongna;CHEN Xinghe;HUA Hongguo;WANG Na;WU Dan(First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院,河北秦皇岛066000

出　　处：《中国实用神经疾病杂志》2025年第1期28-32,共5页Chinese Journal of Practical Nervous Diseases

基　　金：秦皇岛市科学技术研究与发展计划项目(编号:202301A164)。

摘　　要：目的分析外伤性脑出血(ICH)患者术后感染病原菌分布特点及血清降钙素原(PCT)和淀粉样蛋白A(SAA)变化的意义。方法回顾性选取2020-05—2023-05秦皇岛市第一医院收治的122例外伤性ICH患者,根据术后是否发生感染分为感染组(42例)和未感染组(80例),分析感染分布特征以及病原菌分布,采用酶联免疫吸附试验检测2组患者的血清PCT和SAA水平,ROC曲线评价血清PCT和SAA水平预测外伤性ICH术后发生感染的效能。结果42例外伤性ICH患者术后感染部位以呼吸道为主,占比54.76%,其次为颅内和胃肠道,占比分别为19.05%、14.29%。感染部位共分离出65株病原菌,其中革兰阴性菌占52.31%,以肺炎克雷伯菌(16.91%)和铜绿假单胞菌(12.31%)为主;革兰阳性菌占44.61%,以D型溶血性链球菌(13.84%)为主;真菌占3.08%,主要为白假丝酵母菌(3.08%)。ROC曲线分析显示,血清PCT和SAA及联合预测术后感染的曲线下面积分别为0.813、0.780、0.885(P<0.05)。血清PCT和SAA联合检测预测术后感染的灵敏度80.36%,特异度85.26%。结论外伤性ICH患者术后感染病原菌以革兰阴性菌(肺炎克雷伯菌、铜绿假单胞菌)和革兰阳性菌(D型溶血性链球菌)为主,血清PCT联合SAA检测对外伤性ICH患者术后发生感染有较好的预测价值。Objective To analyze the distribution characteristics of postoperative infection pathogens in patients with traumatic intracerebral hemorrhage(ICH)and significance of the changes of serum procalcitonin(PCT)and amyloid A(SAA).Methods A retrospective selection was performed on the 122 patients with traumatic ICH undergoing surgical treatment in the First Hospital of Qinhuangdao between May 2020 and May 2023.According to presence or absence of postoperative infection,they were divided into infection group(42 cases)and non-infection group(80 cases).The distribution characteristics of infection and distribution of pathogens were analyzed.The levels of serum PCT and SAA in both groups were detected by enzyme-linked immunosorbent assay(ELISA).The predictive efficiency of serum PCT and SAA levels for infection was evaluated by ROC curves.Results In the 42 patients with traumatic ICH,the main infection sites included respiratory tract(accounting for 54.76%),followed by intracranial and gastrointestinal tract(accounting for 19.05%,14.29%,respectively).There were 65 strains of pathogens isolated from infection sites,including Gram-negative bacteria(accounting for 52.31%,mainly on klebsiella pneumoniae(accounting for 16.91%)and pseudomonas aeruginosa(accounting for 12.31%)),Gram-positive bacteria(accounting for 44.61%,mainly on D-type hemolytic streptococcus(accounting for 13.84%))and fungi(accounting for 3.08%,mainly on candida albicans(accounting for 3.08%)).The results of ROC curves analysis showed that area under the curve(AUC)values of serum PCT,SAA and combined detection for predicting postoperative infection were 0.813,0.780 and 0.885,respectively(P<0.05).The sensitivity and specificity of the combined detection of serum PCT and SAA for predicting postoperative infection were 80.36%and 85.26%,respectively.Conclusion Postoperative infection pathogens in patients with traumatic ICH are mainly on Gram-negative bacteria(klebsiella pneumoniae,pseudomonas aeruginosa)and Gram-positive bacteria(D-type hemolytic streptococcus)

关 键 词：外伤性脑出血 术后感染 降钙素原 淀粉样蛋白A 血清 预测价值 

分 类 号：R743.34[医药卫生—神经病学与精神病学]