| Objective1.All subjects were divided into postoperative bacterial intracranial infection group,postoperative uninfected group,non-bacterial intracranial infection group and control group.The levels of heparin-binding protein(HBP),white blood cell(WBC),neutrophils,total protein(TP),procalcitonin(PCT)in cerebrospinal fluid(CSF)and serum PCT levels were measured of all patients,and the differences of the laboratory test indicators in each group were statistically analyzed to investigate the clinical application value of the levels of HBP in cerebrospinal fluid for bacterial intracranial infection and non-bacterial intracranial infection.2.Make receiver operating characteristic curve(ROC)curve analysis and compare the diagnostic performance of each test index for bacterial intracranial infection and the differential diagnosis performance of bacterial and non-bacterial intracranial infection.3.Patients with bacterial intracranial infection were divided into groups according to the degree of intracranial infection,Glasgow Outcome Scale Score(GOS)and infected strain type.The concentration of HBP in cerebrospinal fluid of each group was tested to determine the relationship between the degree of intracranial infection,prognosis and the strain type of infection and the levels of HBP in cerebrospinal fluid.Methods From December 2016 to May 2018,150 patients with suspected intracranial infection after craniotomy in neurology department of the People’s Hospital of Liaoning Province were selected.73 patients with bacterial intracranial infection after craniotomy were included in the group of bacterial intracranial infection after diagnosis,and 77 patients without any infection were included in the postoperative uninfected group.At the same time,14 patients with non-bacterial intracranial infection in the same period were collected without surgery,32 patients with cerebrospinal fluid WBC<10×106/L non-intracranial infectious diseases were collected as the control group.The concentrations of HBP in CSF were tested with latex immunoturbidimetry.The concentrations of PCT in cerebrospinal fluid and serum were tested with electrochemiluminescence.The cerebrospinal fluid routine were tested with instrument method.The concentrations of TP in cerebrospinal fluid were detected by turbidimetry.The differences of the laboratory test indicators in each group were statistically analyzed,and the levels of HBP in cerebrospinal fluid of patients with different degrees of intracranial infection,prognosis and different infected strain types were compared.Comparison of two independent samples was performed using the Mann-Whitney U test.The ROC curve was drawn to evaluate the diagnostic performance of the test indicators for bacterial intracranial infection and the differential diagnosis performance of bacterial and non-bacterial intracranial infection.A scatter plot of the concentration distribution of each inflammatory index was prepared using Graph Pad Prism 5.0.Spearman correlation test was used to analyze the correlation between HBP levels in cerebrospinal fluid and bacterial intracranial infectious patients with GOS score and neutrophils levels.Results1.The levels of HBP,WBC,neutrophils,PCT in CSF and serum PCT in the post-craniotomy bacterial intracranial infection group were significantly higher than those in the uninfected group after craniotomy(Z=-9.246,-6.759,-6.741,-4.477,-6.202,P<0.05),non-bacterial intracranial infection group(Z=-5.840,-5.412,-5.259,-2.923,-5.104,P<0.05)and the control group(Z=-7.905,-7.919,-7.335,-4.397,-5.474,P<0.05).There were significant differences in the levels of HBP,WBC and neutrophils in CSF(Z=-3.763,-3.444,-3.041,P<0.05)and no significant differences in CSF and serum PCT(Z=-0.869,-1.850,P>0.05)between the uninfected group after craniotomy and the non-bacterial intracranial infection group.There were significant differences in the levels of HBP,WBC and neutrophils in CSF(Z=-4.496,-6.685,-4.842,P<0.05)and no significant differences in CSF and serum PCT(Z=-0.676,-1.303,P>0.05)between the uninfected group after craniotomy group and the control group.There were no significant differences in the levels of HBP,PCT in CSF and serum PCT(Z=-0.861,-0.514,-0.273,P>0.05)and significant differences in the levels of WBC and neutrophils in CSF(Z=-2.756,-3.060,P<0.05)between the non-bacterial intracranial infection group and the control group.2.The areas under the ROC curve for the diagnosis of bacterial intracranial infection by HBP,WBC,neutrophils,TP,PCT in cerebrospinal fluid and PCT in serum were 0.986,0.987,0.945,0.945,0.770 and 0.914,respectively.The areas under the ROC curve for differential diagnosis of bacterial intracranial infection and non-bacterial intracranial infection were0.994,0.958,0.961,0.929,0.747 and 0.936,respectively.3.The levels of HBP in cerebrospinal fluid in the severe intracranial infection group were significantly higher than those in the mild intracranial infection group(Z=-6.267,P<0.05).The levels of HBP in cerebrospinal fluid in the poor prognosis group were significantly higher than those in the good prognosis group(Z=-7.064,P<0.05).The levels of HBP in the cerebrospinal fluid of the infected Gram-negative bacteria group were significantly higher than those in the infected Gram-positive bacteria group and the CSF culture-negative group(Z=-3.963,-4.198,P<0.05)and there were no significant differences in HBP levels of the cerebrospinal fluid between the infected Gram-positive bacteria group and the CSF culture-negative group.(Z=-0.112,P>0.05).Conclusion1.Compared with traditional indicators of cerebrospinal fluid WBC,neutrophils,TP,PCT and serum PCT,HBP in cerebrospinal fluid is an ideal infective marker for the diagnosis of bacterial intracranial infection,and helps to differentially diagnose bacterial and non-bacterial intracranial infection.2.The magnitude of elevated HBP in cerebrospinal fluid is associated with the severity and prognosis of intracranial infection and can help assess the severity of intracranial infection and patient outcomes. |
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