血清PCT、IL-6、CRP在颅脑损伤术后颅内感染的早期诊治中的价值
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摘要
目的探讨血清降钙素原(PCT)、白介素-6(IL-6)、C-反应蛋白(CRP)对颅脑损伤术后早期颅内感染的诊断价值。方法选取2016年1月至2018年1月收治的颅脑损伤术后颅内感染23例作为感染组,同期颅脑损伤术后未出现颅内感染46例作为对照组。感染组给予万古霉素及美罗培南治疗。术后12 h内采取空腹肘静脉血5 ml,采用双抗体夹心免疫化学发光法半定量快速实验测定血清PCT含量,采用全自动免疫透视比浊法测定血清CRP含量,采用全自动免疫化学发光法测定血清IL-6含量。感染组给药第1、3、6、9、12天(五次)清晨空腹采取肘静脉血5 ml检测血清PCT、IL-6、CRP。采用受试者工作特征(ROC)曲线判断各指标对颅内感染的诊断效能。结果感染组23例中,12例治愈,6例好转,5例无效或加重;感染控制18例,未控制5例。术后12 h内,感染组血清PCT、CRP、IL-6浓度均明显高于对照组(P<0.05)。感染控制组血清PCT和CRP浓度显著低于未控制组(P<0.05)。血清PCT、CRP、IL-6判断颅内感染最佳截断值分别为0.51 ng/ml、16.25 mg/ml、32.67 pg/ml,敏感性分别为52.2%、91.3%、91.3%,特异性分别为82.6%、79.4%、87.0%;三者联合判断颅内感染的敏感性为100.0%,特异性为79.3%。结论血清PCT、IL-6和CRP均有助于早期诊断颅脑损伤术后颅内感染,三者联合检测对于诊断颅内感染效果更好。
Objective To investigate the value of serum procalcitonin(PCT), interleukin-6(IL-6) and C-reactive protein(CRP levels in the diagnosis of postoperative intracranial infection(PII) in patients with traumatic brain injury(TBI). Methods The clinical data of 69 patients with TBI undergoing the surgery from January, 2016 to January 2018, of whom 23 suffered from PII(infection group)and 46 did not(control group), were analyzed retrspectively. The serum PCT, CRP and IL-6 levels were determined 12 hours after the operation in all the patients and 1, 3, 6, 9 and 14 days after the antibiotic therapy in 23 patients with intracranial infection. Results Of23 patients with PII, 18 were cured and 5 not. The levels of serum PCT, CRP and IL-6 12 hours after the operation were significantly higher in the infection group than those in the control group(P<0.05). The levels of serum PCT and CRP after the treatment were significantly lower in the patients who were cured than those who were not(P<0.05). The ROC curve showed that the best cut-off values of serum PCT, CRP, and IL-6 to the diagnosis of the PII were 0.51 ng/ml, 16.25 mg/ml and 32.67 pg/ml, respectively. The sensitivity of the serum PCT, CRP and IL-6 level to the diagnosis of PII were 52.2%, 91.3% and 91.3%, respectively. The specificity of the serum PCT, CRP and IL-6 level to the diagnosis of PII were 82.6%, 79.4% and 87.0%, respectively. The sensitivity and specificity of serum PCT, CRP combined with IL-6 to the diagnosis of PII were 100.0% and 79.3%, respectively. Conclusions The levels of serum PCT,CRP and IL-6 are helpful to the diagnosis of PII, and the levels of serum CRP and PCT are of value to the assessment of curative effects on the PII in the patients with TBI.
Objective To investigate the value of serum procalcitonin(PCT), interleukin-6(IL-6) and C-reactive protein(CRP levels in the diagnosis of postoperative intracranial infection(PII) in patients with traumatic brain injury(TBI). Methods The clinical data of 69 patients with TBI undergoing the surgery from January, 2016 to January 2018, of whom 23 suffered from PII(infection group)and 46 did not(control group), were analyzed retrspectively. The serum PCT, CRP and IL-6 levels were determined 12 hours after the operation in all the patients and 1, 3, 6, 9 and 14 days after the antibiotic therapy in 23 patients with intracranial infection. Results Of23 patients with PII, 18 were cured and 5 not. The levels of serum PCT, CRP and IL-6 12 hours after the operation were significantly higher in the infection group than those in the control group(P<0.05). The levels of serum PCT and CRP after the treatment were significantly lower in the patients who were cured than those who were not(P<0.05). The ROC curve showed that the best cut-off values of serum PCT, CRP, and IL-6 to the diagnosis of the PII were 0.51 ng/ml, 16.25 mg/ml and 32.67 pg/ml, respectively. The sensitivity of the serum PCT, CRP and IL-6 level to the diagnosis of PII were 52.2%, 91.3% and 91.3%, respectively. The specificity of the serum PCT, CRP and IL-6 level to the diagnosis of PII were 82.6%, 79.4% and 87.0%, respectively. The sensitivity and specificity of serum PCT, CRP combined with IL-6 to the diagnosis of PII were 100.0% and 79.3%, respectively. Conclusions The levels of serum PCT,CRP and IL-6 are helpful to the diagnosis of PII, and the levels of serum CRP and PCT are of value to the assessment of curative effects on the PII in the patients with TBI.
引文
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[10]Knudsen TB, Larsen K, Kristiansen TB, et al. Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis:comparison with CRP and procalcitonin[J].Scand J Infect Dis, 2007, 39(6-7):542-553.
[11]周振军,孙新,林文平.探讨降钙素原在颅脑手术术后颅内感染的诊断价值[J].中华神经医学杂志,2013,12:621-624.
[12]Jagminas L. Meta-analysis:procalcitonin-guided antibiotic therapy reduces treatment failure in acute respiratory infection[J]. Ann Intern Med, 2013, 158(4):2005-2008.
[13]张洪微,窦榕榕,渠雪红,等.血清降钙素原在开颅术后颅内感染早期诊断中的价值[J].中国临床神经外科杂志,2016,21(12):756-758.
[14]郭靓,王占科.降钙素原生化特征及其临床应用[J].现代诊断与治疗,2009,20:217-219.
[2]宋琦,王永和,曹培成,等.神经外科术后颅内感染的临床分析[J].中国临床神经外科杂志,2012,17(3):181-183.
[3]姚国杰,徐国政,龚杰,等.开颅术后颅内感染的危险因素及防治措施[J].中国临床神经外科杂志,2009,14(9):532-534.
[4]刘瑶,王毅,于湘友.降钙素原、血沉、C反应蛋白对ICU颅脑术后患者颅内感染的诊断价值[J].中国感染控制杂志,2017,6(11):1008-1011.
[5]陈幼华,罗晋卿,蔡永林,等.颅脑手术患者医院感染危险因素[J].中国感染控制杂志,2016,15(1):34-37.
[6]武元星,郝京京,王强.血清及脑脊液降钙素原在神经外科术后颅内感染早期诊断中的应用[J].中国临床神经外科杂志,2017,22(4):237-238,241.
[7]中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识[J].中华结核和呼吸杂志,2017,40(4):243-257.
[8]Nierhaus A, Klatte S, Linssen J, et al. Revisiting the white blood cell count:immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis-a prospective, observational study[J]. BMC Immunol, 2013,14:8.
[9]张翼,余刚.降钙素原在颅内感染中的临床应用研究进展[J].中国全科医学,2012,15:27-32.
[10]Knudsen TB, Larsen K, Kristiansen TB, et al. Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis:comparison with CRP and procalcitonin[J].Scand J Infect Dis, 2007, 39(6-7):542-553.
[11]周振军,孙新,林文平.探讨降钙素原在颅脑手术术后颅内感染的诊断价值[J].中华神经医学杂志,2013,12:621-624.
[12]Jagminas L. Meta-analysis:procalcitonin-guided antibiotic therapy reduces treatment failure in acute respiratory infection[J]. Ann Intern Med, 2013, 158(4):2005-2008.
[13]张洪微,窦榕榕,渠雪红,等.血清降钙素原在开颅术后颅内感染早期诊断中的价值[J].中国临床神经外科杂志,2016,21(12):756-758.
[14]郭靓,王占科.降钙素原生化特征及其临床应用[J].现代诊断与治疗,2009,20:217-219.