脑脊液生化指标在中枢神经系统感染诊断中的价值

摘要

Objective To explore the diagnostic value of cerebrospinal fluid(CSF) biochemical indexes in central nervous system (CNS) infection .Methods The results of CSF culturing and detection of biochemical indexes including glucose(Glu) ,lactate dehy‐drogenase(LDH) ,chloride ion(Cl) and protein(PRO) were collected from the First Affiliated Hospital of Xi′an Jiaotong University from September to December 2013 .Taking the results of CSF culturing as golden standard ,the biochemical indexes were analyzed by using receiver‐operating characteristic(ROC) curve for single index and combined indexes .Results A total of 157 CSF speci‐mens were collected ,including 39 culture‐positive specimens and 118 culture‐negative specimens .Areas under ROC curve(AUC) of Glu ,LDH ,Cl and PRO were 0 .653 ,0 .633 ,0 .626 ,0 .671 ,respectively .The AUCs of combined detection of these biochemical inde‐xes were higher than those of single index ,and the AUC of combined detection of these four indexes was the largest ,up to 0 .694 , but all were less than 0 .7 .Conclusion Glu ,LDH ,Cl and PRO all could be independent biochemical indexes for diagnosing CNS in‐fection ,among which PRO has the highest diagnostic value .And combined detections of these indexes are better than single detec‐tions ,especially combination of four indexes ,which is the strongest indicator ,but accuracy is low whether single or combined detec‐tion .More sensitive and specific biomarkers of CSF should be explored for rapid diagnosis of CNS infection .%目的：探讨生化指标在中枢神经系统（CNS）感染诊断中的价值。方法收集西安交通大学第一附属医院2013年9～12月脑脊液（CSF）培养结果与葡萄糖（Glu）、乳酸脱氢酶（LDH）、氯化物（Cl）、蛋白质（PRO）4项生化指标检测结果，以培养结果作为金标准，对生化指标分别进行单项与联合指标受试者工作特征（ROC）曲线分析。结果共收集CSF标本157份，其中培养阳性39份，阴性118份。Glu、LDH、Cl、PRO的ROC曲线下面积（AUC）分别为0．653、0．633、0．626、0．671。联合检测指标的AUC均高于单项检测，4项指标同时检测的AUC（0．694）最高，但仍低于0．7。结论 Glu、LDH、Cl、PRO均可作为CNS感染的独立诊断指标，其中PRO诊断价值最高；而联合检测优于单项检测，且4项指标联合检测诊断价值最高，但准确度均较低，临床需要寻求更加灵敏与特异的CSF标志物用于CNS感染的快速诊断。