张二辉;白奎;王玉珍;高海波;张春民;杨超;方树民;

• 1:河南大学第一附属医院重症医学科
• 2:河南大学第一附属医院神经外科

摘要(Abstract)：

目的研究血脑脊液炎症标记物(PCT、CRP)及WBC计数在神经外科术后颅内感染的诊断。方法收集神经外科术后颅内感染患者(n=35)和非颅内感染患者(n=35)的脑脊液和血液样本,检测脑脊液和血清PCT、CRP与脑脊液和血液白细胞计数等指标并进行统计分析。结果颅内感染研究组CSF与血清中降钙素原、C-反应蛋白、白细胞计数均较非感染对照组显著升高(P<0.05)。CSF中降钙素原与血清中降钙素原水平差异不明显(P>0.05)。结论脑脊液与血清PCT、CRP、白细胞计数在颅脑手术术后颅内感染的诊断中均有意义,其中脑脊液与血清PCT、脑脊液白细胞计数诊断价值更大。

关键词(KeyWords)： 降钙素原;C反应蛋白;白细胞计数;脑脊液;颅内感染

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 张二辉;白奎;王玉珍;高海波;张春民;杨超;方树民;

参考文献(References)：

• [1] TAYLOR C L.Neurosurgical practice liability:relative risk by procedure type[J].Neurosurgery,2014,75(6):609-613.
• [2] THRANE J F,SUNDE N A,BERGHOLT B,et al.Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation[J].Stereotact Funct Neurosurg,2014,92(6):360-364.
• [3] XU H,HU F,HU H,et al.Antibiotic prophylaxis for shunt surgery of children:a systematic review[J].childs Nerv Syst,2016,32(2):253-258.
• [4] RFICHEN M C,MEDEIROS E A,FERRAZ F A,et al.Hospital-acquired meningitis in patients undergoing ranlotomy:Incidence,evolution and risk factors[J].Am J Infect Control,2002,30(3):58-64.
• [5] ORRU C D,HUGHSON A G,RACE B,et al.Time course of prion seeding activity in cerebrospinal fluid of scrapie-infectedhamsters after intratongue and intracerebral inoculations[J].J Clin Microbiol,2012,50(4):1 464-1 466.
• [6] IBRAHIM K A,ABDEL-WAHAB A A,IBRAHIM A S et al.Diagnostic value of seram procalcitonin levels in children with meningitis:a comparison with blood leukocyte count and C-reactive protein[J].J Pak Med Assoc,2011,61(4):346-351.
• [7] 中华人民共和国卫生部.医院感染诊断标准(试行)摘登(1)[J].新医学,2005,36(8):495.
• [8] 中华人民共和国卫生部.医院感染诊断标准(试行)摘登(2)(续前)[J].新医学,2005,36(12):735.
• [9] 许刚,张帆,陈谦学,等.颅脑术后并发颅内感染的高危因素分析[J].中国临床神经外科杂志,2008,13(6):362-364.
• [10] LAYIOS N,LAMBERMONT B,CANIVET J L,et al.Procalcitoninusefulness for the initiation of antibiotic treatmen in intensive care unit patients[J].Crit Care Med,2012,40(8):2 304-2 309.
• [11] LEE JY,LEE JH,KIM DK,et al.C-reactive protein as a prognostic factor for mortality in pneumonia patients with liver cirrhosis[J].Hepatogastroenterolo-gy,2014,61(133):1 331-1 338.
• [12] 占林兵,谢波,华锋,等.血清C 反应蛋白、降钙素原及乳酸在重症肺炎中的变化及临床意义[J].中华全科医学,2015,13(3):367-368,404.
• [13] 姚建华,谢立德,汪健蕾,等.动脉血乳酸和C-反应蛋白对重症肺炎预后的评估价值[J].临床肺科杂志,2013,18(4):600-601.
• [14] 杜斌.脑脊液降钙素原及C反应蛋白在颅内感染鉴别诊断中的应用价值[J].实用心脑肺血管病杂志2014,22(11):75-76.
• [15] TOMIO R,AKIYAMA T,SHIBAO S,et al.Procalcitonin as an early diagnostic marker for ventriculoperitoneal shunt infections[J].Surg Infect(Larchmt),2013,14(5):433-436.
• [16] CHU C M,KAO KC,HUANG S H,et al.Diagnostic value of apoptosis biomarkers in severe sepsis-A pilot study[J].Cell Mol Biol( Noisy-le-grand),2016,62(11):32-37.
• [17] AZEVEDO J R,TORRES D J,CZECZKO N G,et al.Procalcitonin as a prognostic biomarker of severe sepsis and septic shock[J].Rev Col Bras Cir,2012,39(6):456-460.
• [18] ALKHOLI U M,ABD AL-MOMEM N,ABD EL-AZIM A A,et al.Serum procalcitonin in viral and bacterial meningitis[J].J Glob Infect Dis,2011,3(1):14-18.
• [19] DAVIDSON J,TONG S,HAUCK A,et al.Kinetics of procalcitonin and C-reactive protein and the relationship to postoperativeinfection in young infants undergoing cardiovascular surgery[J].Pediatr Res,2013,74(4):413-419.
• [20] BECKER K L,SNIDER R,NYLEN ES.Procalcitonin in sepsis and systemic inflammation:a harmful biomarker and a therapeutic target[J].Br J Pharmacol,2010,159(2):253-264.
• [21] SCHUETZ P,ALBRICH W,MUELLER B.Procalcitonin for diagnosis of infection and guide to antibiotic decisions:past,present and future[J].BMC Med,20ll,9:107.
• [22] TIAN G,PAN SY,MA G,et al.Serum levels of procalcitonin as a biomarker for differentiating between sepsis and systemic inflammatory response syndrome in the neurological intensive care unit[J].J Clin Neurosci,2014,21(7):1 153-1 158.
• [23] CHUI H J.Procalcitonin in diagnosis of post-operative bacterialmeningitis:a promising but limited role[J].Infect Chemother,2013,45(3):346-348.
• [24] 降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识[J].中华急诊医学杂志,2012,21(9):944-951.
• [25] 李建民,赵雅宁,王袁.开颅术后颅内感染患者血清与脑脊液相关指标测定的临床意义[J].中华医院感染学杂志,2015,25(14):3 138-3 140.
• [26] ALKHOLIi U M,ABDALMONEM N,ABELAZIM A A,et al.Serum procalcitonin in viral and bacterial meningitis[J].J Glob Infect DIS,2011,3(1):14-18.
• [27] JEREB M,MUZLOVIC L,HOJKER S,et al.Predoctive value of serum and cerebrospinal fluid procalcitonin levels for the diagnosis of bacterial meningitis[J].Infection,2001,29:209.
• [28] 周振军,孙新林,文平,等.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(6):621-624.
• [29] 邓水香,曹同瓦,祝禾辰,等.降钙素原与单纯脑外伤患者病情严重程度、并发症以及预后的关系[J].中华急诊医学杂志,2012,21(9):69-72.
• [30] 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,2017,16(11):1 008-1 011.
• [31] 曾海清,李幽然,张国军,等.脑脊液CRP、CHE、UA在神经外科术后颅内感染诊断价值的研究[J].检验医学与临床,2016,13(9):1 192-1 194.
• [32] 李桂云.血清降钙素原、C 反应蛋白与白细胞在颅脑手术患者发热中的诊断价值分析[J].中南医学科学杂志,2016,44(1):44-47.
• [33] 李萍,王青,李志.血清降钙素原、白细胞介素-6、C-反应蛋白在感染性疾病中的诊断价值[J].检验医学与临床,2014,11(11):1 553-1 555.
• [34] KEPA L,0CZKO-GEZESIK B,BLEDOWSKI D.Procalcitonin(PCT) concentration in cerebrospinal fluid and plasma of patients with purulent and lymphocytic meningoencephalitis-own observations[J].Przegl Epidemiol,2005,59(3):703-709.
• [35] WRODYCKI W.Usefulness of plasma procalcitonin(PCT)estimation to diagnose patients in departments of infectious diseases[J].Przegl Epidemiol,2003,57(1):211-219.
• [36] 李幽然,张国军,高之宪,等.脑脊液降钙素原在鉴别颅内细菌性感染与无菌性脑膜炎中的作用[J].中华神经外科杂志,2015,31(10):997-1 000.
• [37] 郑仕奇,黄庆,张亚卓.降钙素原对术后颅内感染的临床意义[J].中华神经外科杂志,2015,31(3):316-318.
• [38] 刘睿,李钦涛,张旖旎,等.降钙素原对开颅术感染患者的致病菌型别的诊断评价[J].中华医院感染学杂志,2016,26(16):3 744-3 745;3 748.
• [39] 郝京京,武元星,王强.神经外科术后颅内感染的危险因素及降钙素原等炎性标志物的诊断价值[J].临床神经外科杂志,2016,13(5):348-351.
• [40] 赵兵刚,赵威,黄杨,等.血清降钙素原在颅脑损伤继发颅内细菌性感染中的诊断价值[J].中国医学前沿杂志(电子版),2017,9(6):64-67.
• [41] 李钦涛.血清降钙素原清除率对开颅术后颅内感染患者预后的意义[J].中国实验诊断学,2018,22(1):13-14.