摘要：

目的 探讨脑脊液和血清降钙素原对动脉瘤性蛛网膜下腔出血患者神经外科手术后细菌性脑膜炎和（或）脑室炎（PNBM/BV）的诊断价值。方法 前瞻性纳入53例2018年6月至2019年6月行开颅动脉瘤夹闭术的动脉瘤性蛛网膜下腔出血患者，分为PNBM/BV组（25例）和无PNBM/BV组（28例），分别检测脑脊液细胞总数、白细胞计数、蛋白定量和葡萄糖，血糖，脑脊液葡萄糖/血糖比值，以及脑脊液和血清降钙素原；Pearson相关分析和偏相关分析探讨脑脊液降钙素原与脑脊液和血清学指标的相关性；绘制受试者工作特征（ROC）曲线，计算脑脊液和血清降钙素原诊断PNBM/BV的敏感性和特异性。结果 PNBM/BV组患者脑脊液白细胞计数（P=0.011）、蛋白定量（P=0.030），以及脑脊液降钙素原（P=0.000）和血清降钙素原（P=0.010）高于无PNBM/BV组，脑脊液葡萄糖（P=0.000）和脑脊液葡萄糖/血糖比值（P=0.000）低于无PNBM/BV组。相关分析显示，脑脊液降钙素原与血清降钙素原（r=0.421，P=0.002）、脑脊液白细胞计数（r=0.394，P=0.004）呈正相关，而与脑脊液葡萄糖呈负相关（r=-0.327，P=0.018）。ROC曲线显示，脑脊液降钙素原诊断PNBM/BV的曲线下面积为0.835（95% CI：0.710~0.960，P=0.000），灵敏度为88%、特异度82.10%，阳性预测值81.48%（22/27）、阴性预测值88.46%（23/26），诊断截断值0.331 ng/ml；血清降钙素原诊断PNBM/BV的曲线下面积为0.720（95% CI：0.580~0.860，P=0.000），灵敏度为64%、特异度75%，阳性预测值69.57%（16/23）、阴性预测值70%（21/30），诊断截断值0.501 ng/ml。结论 脑脊液和血清降钙素原是诊断动脉瘤性蛛网膜下腔出血患者神经外科手术后PNBM/BV的重要生物学标志物。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, 降钙素, 脑脊髓液, 血清, 手术后并发症, 脑膜炎, 细菌性, 脑室炎

Abstract:

Objective To investigate the role of cerebrospinal fluid (CSF) and serum procalcitonin (PCT) in diagnosis of post-neurosurgical bacterial meningitis/ventriculitis (PNBM/BV) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods A prospective observational study was conducted, and 53 patients with suspected bacterial meningitis after craniotomy were selected from June 2018 to June 2019 in Department of Neurosurgical Intensive Care Unit in Xuanwu Hospital of Capital Medical University. The patients were divided into PNBM/BM group (25 cases) and non-PNBM/BV group (NPNBM/BV, 28 cases). CSF cells count, white blood cell count (WBC), protein quantity and glucose, blood glucose and CSF/blood glucose ratio, and CSF and serum PCT were measured. Pearson correlation analysis and partial correlation analysis were used to explore the correlation between CSF PCT and CSF and serum indicators. The receiver operating characteristic curve (ROC curve) and calculate the area under the curve (AUC) were drawn, and the sensitivity and specificity of CSF and serum PCT in the diagnosis of PNBM/BV were calculated. Results CSF WBC (P=0.011), protein quantity (P=0.030), PCT (P=0.000) and serum PCT (P=0.010) in PNBM/BV group were higher than those in non-PNBM/BV group, while CSF glucose (P=0.000) and CSF/serum glucose ratio (P=0.000) in PNBM/BV group were lower than those in non-PNBM/BV group. Correlation analysis showed that PCT in CSF was positively correlated with serum PCT (r=0.421, P=0.002) and CSF WBC (r=0.394, P=0.004), but negatively correlated with CSF glucose (r=-0.327, P=0.018). The ROC curve showed the AUC of CSF PCT in the diagnosis of PNBM/BV was 0.835 (95% CI:0.710-0.960, P=0.000), the sensitivity was 88%, the specificity was 82.10%, the positive predictive value was 81.48% (22/27), the negative predictive value was 88.46% (23/26), and the diagnostic cutoff value was 0.331 ng/ml. The ROC curve showed the AUC of serum PCT for the diagnosis of PNBM/BV was 0.720 (95% CI:0.580-0.860, P=0.000), the sensitivity was 64%, the specificity was 75%, the positive predictive value was 69.57% (16/23), the negative predictive value was 70% (21/30), and the diagnostic cutoff value was 0.501 ng/ml. Conclusions Detection of CSF and serum PCT has important clinical application value in the diagnosis of PNBM/BV after aSAH.

Key words: Intracranial aneurysm, Subarachnoid hemorrhage, Calcitonin, Cerebrospinal fluid, Serum, Postoperative complications, Bacterial infections, Meningitis, bacterial, Cerebral ventriculitis