脑脊液 CRP 、CHE、UA 在神经外科术后颅内感染诊断价值的研究

摘要

目的：探讨胆碱酯酶（CHE）、尿酸（UA）、C反应蛋白（CRP）在成人神经外科脑肿瘤术后鉴别诊断细菌性脑膜炎和无菌性脑膜炎中的应用价值。方法选取150例神经外科脑肿瘤术后临床怀疑颅内感染的患者，检测脑脊液CHE、UA、CRP水平，比较脑脊液CHE、UA、CRP与传统脑脊液检测指标白细胞、蛋白、糖等的变化情况。按照颅内感染标准，将患者分为感染组（n＝41）和非感染组（n＝109）。结果感染组的CHE、UA、CRP水平较非感染组有显著升高（P＜0．05）。CHE、UA、CRP鉴别诊断细菌性脑膜炎和无菌性脑膜炎的受试者工作特征曲线（ROC曲线）下面积分别为0．774、0．819、0．913；临床诊断界值（敏感性、特异性）分别为373．5 U／L （82．9％、69．2％）、12．85μmol／L（87．8％、64．5％）、0．695 mg／L（92．7％、78．5％）。脑脊液CHE、UA、CRP与传统指标变化趋势一致。结论脑脊液CHE、UA、CRP的检测，有望成为鉴别诊断颅内感染的新型标志物。%Objective To explore the differential diagnostic value of C reactive protein ,cholinesteras and uric acid for bacterial meningitis and aseptic meningitis in adult brain tumor neurosurgery .Methods Totally 150 patients with suspected intracranial infection after neurosurgery were enrolled ,we tested the cerebrospinal fluid level of C re‐active protein ,cholinesterase ,and uric acid ,then they were compared with conventional serum parameters including white blood cell ,protein ,and glucose .Patients were divided into infection group(n=41)and non‐infection group(n=109)according to intracranial infection criteria .Results The levels of C reactive protein ,cholinesteraseand uric acid in infection group were significantly higher than those of the non‐infection group(P<0 .05) .The area under curve of C reactive protein ,cholinesterase ,and uric acid for differentiate diagnosis were 0 .913 ,0 .774 and 0 .819 respectively . The cut off values(sensitivity and specificity)of C reactive protein ,cholinesterase ,and uric acid were 0 .695 mg/L (92 .7% ,78 .5% ) ,373 .5 U/L (82 .9% ,69 .2% ) ,12 .85 μmol/L (87 .8% ,64 .5% ) .T he changing tendency of C reac‐tive protein ,cholinesterase ,and uric acid was consistent with conventional parameters .Conclusion The test of cere‐brospinal fluid C reactive protein ,cholinesterase ,and uric acid is expected to be a novel biomarker for the diagnosis of intracranial infection .