摘要
目的探讨老年脑出血开颅术后不同类型病原菌颅内感染对脑脊液神经特异性烯醇化酶(NSE)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、肝素结合蛋白(HBP)水平的影响。方法选取2019年8月至2021年10月上海交通大学医学院附属瑞金医院116例老年脑出血开颅术患者,根据术后并发颅内感染与否分为感染组35例,非感染组81例。比较两组患者基本情况、术后脑脊液NSE、NLRP3、HBP水平,Logistic回归分析老年脑出血开颅术后颅内感染影响因素,术后行腰椎穿刺采集脑脊液,进行病原菌培养,对比感染组不同病原菌类型患者术后脑脊液NSE、NLRP3、HBP水平,并绘制ROC曲线,评价脑脊液NSE、NLRP3、HBP水平对颅内感染的诊断价值。结果感染组患者术后脑脊液NSE、NLRP3、HBP水平均高于非感染组患者,差异有统计学意义(P<0.05);Logistic回归分析可知,NSE、NLRP3、HBP水平均与老年脑出血开颅术后颅内感染独立相关(P<0.05);35例老年脑出血开颅术后颅内感染患者共分离出42例病原菌,其中革兰氏阴性菌占45.24%,革兰氏阳性菌54.76%;老年脑出血开颅术后颅内革兰氏阴性菌感染患者术后脑脊液NSE、NLRP3、HB P水平均高于革兰氏阳性菌感染患者,差异有统计学意义(P<0.05);ROC曲线显示,脑脊液NSE、NLRP3、HBP联合诊断老年脑出血开颅术后颅内感染的AUC值最高,诊断效能良好(P<0.05)。结论老年脑出血开颅术后颅内感染患者脑脊液NSE、NLRP3、HBP明显升高,检测上述指标水平有助于诊断颅内感染及鉴别革兰氏阴性菌与革兰氏阳性菌感染。
Objective To investigate the value of intracranial infection of different types of pathogenic bacteria on cerebrospinal fluid neuron-specific enolase(NSE),nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),and heparin-binding protein(HBP)after craniotomy in elderly patients with cerebral hemorrhage.Methods A retrospective selection of 116 elderly patients with cerebral hemorrhage craniotomy in our hospital from August 2019 to October 2021 were divided into 35 patients in the infected group and 81 patients in the non-infected group according to whether they had complicated intracranial infection after surgery.The basic conditions of the two groups of patients were compared,the expressions of NSE,NLRP3,and HBP in the cerebrospinal fluid after the operation were measured and analyzed.Logistic regression was used to analyze the factors affecting the intracranial infection after the craniotomy of the elderly with cerebral hemorrhage.After lumbar puncture was performed to collect cerebrospinal fluid,and pathogenic bacteria were cultured.The postoperative cerebrospinal fluid NSE,NLRP3,and HBP levels of patients with different types of pathogens in the infection group were compared,and ROC curves were drawn to evaluate the diagnostic value of NSE,NLRP3 and HBP levels in cerebrospinal fluid for intracranial infection.Results The postoperative cerebrospinal fluid NSE,NLRP3 and HBP levels in the infection group were higher than those in the non-infection group(P<0.05).Logistic regression analysis showed that the levels of NSE,NLRP3 and HBP were independently correlated with intracranial infection after craniotomy in elderly patients with cerebral hemorrhage(P<0.05).A total of 42 pathogenic bacteria were isolated from 35 elderly patients with cerebral hemorrhage and intracranial infection after craniotomy,among which,Gram-negative bacteria accounted for45.24%and Gram-positive bacteria 54.76%.The levels of NSE,NLRP3 and HBP in cerebrospinal fluid of elderly patients with intracranial gram-negative bacterial infection after craniotomy were significantly higher than those of patients with gram-positive bacterial infection(P<0.05).The ROC curve showed that the combination of cerebrospinal fluid NSE,NLRP3,and HBP had the highest AUC value in diagnosing intracranial infection after craniotomy in elderly patients with cerebral hemorrhage,and the diagnostic efficiency was good.Conclusion Cerebrospinal fluid NSE,NLRP3,and HBP were significantly increased in elderly patients with intracranial infection after craniotomy with cerebral hemorrhage.The detection of the above indicators is helpful for the diagnosis of intracranial infection and the identification of gram-negative and gram-positive bacterial infections.
作者
张人菁
黄焰霞
邓云新
陈德昌
ZHANG Renjing;HUANG Yanxia;DENG Yunxin;CHEN Dechang(Department of Critical Medicine,Ruijin Hospital Affiliated to Medical College of Shanghai Jiao Tong University,Shanghai,China,201821)
出处
《分子诊断与治疗杂志》
2022年第1期23-27,共5页
Journal of Molecular Diagnostics and Therapy
基金
上海市嘉定区卫生健康委员会青年基金(2019-QN-04)
上海交通大学医学院附属瑞金医院北院研究基金(2019ZY22)。
