神经内科危重症患者不同致病菌所致颅内感染的脑脊液生化及常规指标差异

目的分析神经内科不同致病菌所致颅内感染的脑脊液生化及常规检测指标，为治疗颅内感染提供理论依据。 方法选取2013年1月至2018年1月于重庆市开州区人民医院就诊的106例神经内科危重症患者为研究对象，其中并发颅内感染者为研究组（59例），非颅内感染者为对照组（47例）。研究组患者根据是否出现昏迷分为未昏迷组（38例）和昏迷组（21例），根据感染类型分为化脓性组（21例）、结核性组（20例）和病毒性组（18例）。应用生化分析仪、ELISA法和速率散射免疫比浊法检测患者脑脊液和血液上清液降钙素原（PCT）、C-反应蛋白（CRP）和神经元特异性烯醇化酶（NSE）水平。 结果化脓性组、结核性组和病毒性组患者脑脊液及血清PCT、CRP和NSE水平均显著高于对照组患者（P均< 0.05）。病毒性组患者血清和脑脊液NSE水平（15.68 ± 6.15）μg/L、（17.06 ± 3.25）μg/L）]显著高于化脓性组患者（11.36 ± 3.54）μg/L、（10.65 ± 3.61）μg/L]和结核性组患者（12.63 ± 4.26）μg/L、（12.89 ± 4.33）μg/L）]（P均< 0.05）。化脓性组患者血清和脑脊液PCT（0.86 ± 0.34）ng/ml、（0.72 ± 0.33）ng/ml]和CRP水平（8.55 ± 2.4）ng/ml、（8.68 ± 2.57）ng/ml]均高于病毒性组和结核性组患者，差异均有统计学意义（P均< 0.05）。昏迷组患者脑脊液和血清PCT、CRP和NSE水平均高于未昏迷组患者和对照组，差异均有统计学意义（P均< 0.05）。 结论神经内科并发颅内感染者脑脊液和血清PCT、CRP和NSE水平能够反映颅内感染病情，为颅内感染的诊断和治疗提供可靠依据。

Difference of biochemical and routine indexes of cerebrospinal fluid of intracranial infection of critically ill patients in neurology department casused by different pathogenic bacteria

ObjectiveTo investigate the biochemical and routine indexes of cerebrospinal fluid (CSF) of patients with intracranial infection caused by different pathogens, and to provide theoretical basis for the treatment of intracranial infection. MethodsFrom January 2013 to January 2018, a total of 106 critically ill patients in the Department of Neurology were selected from Kaizhou District People’s Hospital of Chongqing, including 59 patients with intracranial infection, while 47 cases with non-intracranial infection were taken as control group. Patients in the research group were divided into two groups according to whether had coma or not: uncoma group (38 cases) and coma group (21 cases). According to the type of infection, patients in the research group were divided into suppurative group (21 cases), tuberculous group (20 cases) and viral group (18 cases). The levels of procalcitonin (PCT), C-reactive protein (CRP) and neuron-specific enolase (NSE) in cerebrospinal fluid and blood supernatant were measured by biochemical analyzer, ELISA method and rate scattering immunoturbidimetry. ResultsThe levels of PCT, CRP and NSE in CSF and serum of suppurative group, tuberculous group and viral group were significantly higher than those of control group (all P < 0.05). The NSE levels of serum and CSF in viral group (15.68 ± 6.15) μg/L and (17.06 ± 3.25) μg/L)] were significantly higher than those of suppurative group (11.36 ± 3.54) μg/L and (10.65 ± 3.61) μg/L] and tuberculous group (12.63 ± 4.26) μg/L and (12.89 ± 4.33) μg/L)] (all P < 0.05). The levels of PCT in serum and CSF of patients in suppurative group (0.86 ± 0.34) ng/ml and (0.72 ± 0.33) ng/ml] and levels of CRP (8.55 ± 2.4) ng/ml and (8.68 ± 2.57) ng/ml] were significantly higher than that in viral group and tuberculous group (all P < 0. 05). The levels of PCT, CRP and NSE in cerebrospinal fluid and serum of patients in coma group were significantly higher than those of uncomatose group and control group (all P < 0. 05). ConclusionsThe levels of cerebrospinal fluid (CSF) and serum PCT, CRP and NSE in patients with intracranial infection could reflect the condition of intracranial infection and provide reliable basis for the diagnosis and treatment of intracranial infection.