王华军 陈国忠 周成杰

[摘要] 目的 探討脑脊液、血清降钙素原（PCT）差异对开颅患者颅内感染的诊断价值。 方法 收集我科2015年1月～2018年10月间开颅术后怀疑院内获得性颅内感染患者53例;最后确诊为颅内感染者20例设为研究组，排除颅内感染22例作为对照组，存在其他明确感染者11例被除外。分别比较两组血清、脑脊液PCT水平差异及脑脊液PCT阳性率;通过ROC曲线统计血清PCT、脑脊液PCT及脑脊液-血清PCT差值曲线下面积，并求得其诊断颅内感染最佳截点。 结果 研究组、对照组血清PCT分别为（0.11±0.03）ng/mL、（0.10±0.02）ng/mL，两组组间比较，差异无显著性（P>0.05）;研究组脑脊液PCT为（0.14±0.03）ng/mL，高于对照组的（0.06±0.01）ng/mL，两组间比较差异有统计学意义（P<0.05）;两组脑脊液-血清PCT差值分别为（0.04±0.01）ng/mL、（-0.05±0.01）ng/mL，两组间比较差异有统计学意义（P<0.05）;脑脊液PCT、血清PCT、血清-脑脊液PCT差值ROC曲线下面积分别为0.91、0.52、0.80，三组间两两比较差异有统计学意义（P<0.05），脑脊液PCT诊断颅内感染最佳截点为0.08 ng/mL。 结论 提高脑脊液PCT截点或以脑脊液PCT≥血清PCT可用于开颅术后获得性颅内感染的诊断。

[关键词] 颅内感染;降钙素原;血清;脑脊液

[中图分类号] R651.1          [文献标识码] A          [文章编号] 1673-9701（2020）06-0005-04

[Abstract] Objective To investigate the diagnostic value of cerebrospinal fluid and serum procalcitonin （PCT） differences in intracranial infection in patients with craniotomy. Methods A total of 53 patients with suspected in-hospital acquired intracranial infection after craniotomy between January 2015 and October 2018 were enrolled. 20 cases finally diagnosed with intracranial infection was set as the study group， and 22 cases of excluding intracranial infection were set as the control group， and 11 cases of other clearly infected cases were excluded. The differences of serum and cerebrospinal fluid PCT levels and positive rate of cerebrospinal fluid PCT were compared between the two groups. The area under the curve of serum PCT， cerebrospinal fluid PCT and cerebrospinal fluid-serum PCT difference was analyzed by ROC curve， and the best cut-off point for the diagnosis of intracranial infection was obtained. Results Serum PCT of the study group and the control group were （0.11±0.03）ng/mL and （0.10±0.02）ng/mL，respectively. There was no significant difference between the two groups（P>0.05）. The PCT of the study group was （0.14±0.03）ng/mL，which was higher than （0.06±0.01）ng/mL of the control group. The difference between the two groups was statistically significant（P<0.05）. The cerebrospinal fluid-serum PCT difference was （0.04±0.01）ng/mL， （-0.05±0.01）ng/mL， and the difference between the two groups was statistically significant（P<0.05）. The area under the ROC curve of cerebrospinal fluid PCT， serum PCT， and serum-cerebrospinal fluid PCT difference were 0.91， 0.52， and 0.80， respectively，and the difference between the three groups was statistically significant（P<0.05）. The optimal cut-off point for cerebrospinal fluid PCT in diagnosis of intracranial infection was 0.08 ng/mL. Conclusion Increasing the cerebrospinal fluid PCT cut-off point or cerebrospinal fluid PCT greater than or equal to serum PCT can be used for the diagnosis of acquired intracranial infection after craniotomy.

[Key words] Intracranial infection; Procalcitonin; Serum; Cerebrospinal fluid

颅内感染是神经外科术后常见的并发症，占外科患者医院感染的35%～40%[1]，我国发生率为2.6%[2]。一旦发生颅内感染，将造成患者神经损伤加重、住院时间延长、费用增加、甚至危及患者生命等严重后果[3]。近年来在鲍曼不动杆菌及肺炎克雷伯亚种为主的多重耐药细菌检出率增加趋势背景下，给治疗带来极大困难[4]。尽早确诊，积极进行干预治疗是改善预后，减少临床费用的关键。诊断颅内感染目前缺少特异性症状和体征，脑脊液常规、生化等检查影响因素多，脑脊液病原学培养耗时长，且阳性率低，不利于早期诊断。一旦诊断延误，治疗不及时将进一步加重神经损害。近年来研究发现PCT在颅内感染患者的血清及脑脊液中增高，提示PCT的增高可用于颅内感染[5]。本研……