脑脊液乳酸及降钙素原对诊断神经外科术后细菌性脑膜/脑室炎的应用探讨

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英文篇名：Application of cerebrospinal fluid lactate and procalcitonin in the diagnosis of post-neurosurgical bacterial meninges/ventriculitis 作者：张玲 ; 杨启纲 ; 程宏伟 ; 邵敏 英文作者：Zhang Ling;Yang Qigang;Cheng Hongwei;Dept of Critical Care Medicine,The First Affiliated Hospital of Anhui Medical University;Dept of Neurosurgery,The First Affiliated Hospital of Anhui Medical University; 关键词：神经外科术后 ; 细菌性脑膜/脑室炎 ; 脑脊液 ; 乳酸 ; 降钙素原 英文关键词：post-neurosurgical operation;;bacterial meninges/ventriculitis;;cerebrospinal fluid;;lactate;;procalcitonin 中文刊名：YIKE 英文刊名：Acta Universitatis Medicinalis Anhui 机构：安徽医科大学第一附属医院重症医学科;安徽医科大学第一附属医院神经外科; 出版日期：2019-05-09 10:21 出版单位：安徽医科大学学报 年：2019 期：v.54 基金：安徽省转化医学研究院科研基金项目(编号:2017zhyx10) 语种：中文; 页：YIKE201905021 页数：5 CN：05 ISSN：34-1065/R 分类号：100-104

摘要

目的探讨脑脊液乳酸(Lac)及降钙素原(PCT)对神经外科术后细菌性脑膜/脑室炎(PNBM/BV)的诊断价值。方法采用前瞻性观察性研究,收集61例神经外科术后患者的临床资料和脑脊液指标,按有无PNBM/BV分为两组,比较两组脑脊液Lac和PCT有无差异,并绘制受试者工作特征(ROC)曲线,描述二者的诊断效力。结果①与无PNBM/BV组相比,PNBM/BV组脑脊液Lac、PCT、白细胞数、多核百分比、总蛋白水平升高(P<0.001),脑脊液糖/血糖值降低(P<0.001)。②ROC曲线结果显示:脑脊液Lac和PCT对PNBM/BV均具有良好的诊断效力,曲线下面积(AUC)分别为0.990和0.860;脑脊液Lac的诊断截断值为4.35 mmol/L,敏感度为100%,特异度为93.3%;脑脊液PCT的诊断截断值为0.235μg/L,敏感度为80.6%,特异度为81.0%;脑脊液Lac联合PCT对PNBM/BV的诊断效力优于其他指标,AUC为0.990,敏感度为100%,特异度为94.2%。③脑出血和非脑出血患者的脑脊液Lac及PCT差异无统计学意义。结论脑脊液Lac及PCT检测对PNBM/BV均具有较好的诊断价值,尤其是脑脊液Lac。脑脊液Lac联合PCT检测能进一步提高对PNBM/BV的诊断效力。
        Objective To evaluate the diagnostic value of cerebrospinal fluid(CSF) lactate(Lac) and procalcitonin(PCT) for post-neurosurgical bacterial meninges/ventriculitis(PNBM/BV).Methods By prospective observational study, the clinical data and CSF indexes of 61 patients after neurosurgery operation were collected. The patients were divided into two groups according to the presence or absence of PNBM/BV,and the differences of CSF Lac and PCT were compared between the two groups. The receiver operating characteristic( ROC) curve of the subjects were plotted to describe the diagnostic efficacy of CSF Lac and PCT. Results Compared with the non-PNBM/BV group,the levels of CSF Lac,PCT,leukocyte count,polynuclear percentage and total protein of the PNBM/BV group were significantly increased( P < 0. 001),and the value of CSF glucose/blood glucose was significantly decreased( P < 0. 001). ROC curve results showed that both CSF Lac and PCT were effective in diagnosing PNBM/BV,and the area under ROC curve( AUC) could reach 0. 990 and 0. 860,respectively. The diagnostic cutoff value of CSF Lac was 4. 35 mmol/L,with sensitivity 100% and specificity 93. 3%. The diagnostic cutoff value of CSF PCT was 0. 235 μg/L,with sensitivity 80. 6% and specificity 81. 0%. The diagnostic efficacy of CSF Lac combined with PCT for PNBM/BV was better than other indexes,with the AUC of 0. 990,the sensitivity of 100% and the specificity of 94. 2%. CSF Lac and PCT in patients with cerebral hemorrhage and non-cerebral hemorrhage showed no statistical difference. Conclusion The detections of CSF Lac and PCT all have good diagnostic value for PNBM/BV,especially CSF Lac. The combined detection of CSF Lac and PCT can further improve the diagnostic efficacy of PNBM/BV.

引文

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