脑肿瘤术后颅内感染危险因素及脑脊液HBP和PCT与MMP-9水平

目的探讨脑肿瘤术后颅内感染的危险因素,分析脑脊液肝素结合蛋白(HBP)、降钙素原(PCT)、基质金属蛋白酶-9(MMP-9)水平对颅内感染的诊断鉴别价值。方法选取2018年12月-2019年12月北京天坛医院行脑肿瘤术的颅内肿瘤患者105例,进行脑脊液生化检查及病原菌培养诊断患者术后是否发生颅内感染,以多因素Logistic回归探讨危险因素。检测脑脊液HBP、PCT、MMP-9水平,以受试者工作特征曲线(ROC)分析评估诊断价值。结果33例患者术后发生颅内感染,手术时间≥4 h、术后留置引流时间≥24 h、术后脑脊液漏是患者术后发生颅内感染的独立危险因素。颅内感染诊断:脑脊液HBP≥12.86μg/L,灵敏度为93.90%,特异度为70.80%;脑脊液PCT≥0.69μg/L,灵敏度为81.80%,特异度为83.30%;脑脊液MMP-9≥102.96μg/L,灵敏度为87.90%,特异度为91.70%。治疗3 d、7 d、10 d后,颅内感染患者的脑脊液HBP、PCT、MMP-9水平逐渐下降,与治疗前比较差异有统计学意义(P<0.05)。结论脑肿瘤术后颅内感染的高危因素包括手术时间、术后留置引流时间、术后脑脊液漏,对高危患者应及早预防。脑脊液HBP、PCT、MMP-9对颅内感染有较好的辅助诊断价值。

Risk factors for postoperative intracranial infection in intracranial tumor patients and levels of cerebrospinal fluid HBP,PCT and MMP-9

OBJECTIVE To explore the risk factors for postoperative intracranial infection in the intracranial tumor patients and analyze the value of cerebrospinal fluid(CSF)heparin binding protein(HBP),procalcitonin(PCT)and matrix metalloproteinase-9(MMP-9)in differential diagnosis of intracranial infection.METHODS Totally 105 intracranial tumor patients who underwent brain tumor surgery in Beijing Tiantan Hospital Affiliated to Capital Medical University from Dec.2018 to Dec.2019 were enrolled in the study,the intracranial infection was diagnosed by means of CSF biochemical test and culture of pathogens,multivariate logistic regression analysis was performed for risk factors,the levels of CSF HBP,PCT and MMP-9 were detected,and the diagnostic values were evaluated by using receiver operating characteristic(ROC)curve.RESULTS A total of 33 patients had postoperative intracranial infection.Operation duration no less than 4 hours,postoperative drainage tube indwelling time no less than 24 hours and postoperative cerebrospinal fluid leakage were the independent risk factors for the postoperative intracranial infection.The sensitivity and specificity of the CSF HBP no less than 12.86μg/L were respectively 93.90%and 70.80%in diagnosis of intracranial infection;the sensitivity and specificity of the CSF PCT no less than 0.69μg/L were respectively 81.80%and 83.30%;the sensitivity and specificity of the CSF MMP-9 no less than 102.96μg/L were respectively 87.90%and 91.70%.The levels of CSF HBP,PCT and MMP-9 of the patients with intracranial infection were gradually decreased after the treatment for 3,7 and 10 days,and there were significant differences before and after the treatment(P<0.05).CONCLUSION The high risk factors for the postoperative intracranial infection in the intracranial tumor patients include the operation duration,postoperative drainage tube indwelling time and postoperative CSF leakage.It is necessary to carry out early prevention for the high risk patients.The CSF HBP,PCT and MMP-9 have high value in auxiliary diagnosis of the intracranial infection.