Value of peripheral blood adhesion molecules and coagulation function indexes in the diagnosis of recent intracranial infection and prognosis prediction in patients with acute cerebral infarction
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摘要: 目的 探究外周血黏附分子及凝血功能指标在急性脑梗死(acute cerebral infarction，ACI)患者近期颅内感染诊断及预后预测中的价值。 方法 回顾性分析2020年6月—2023年6月中国航天科工集团七三一医院接收的80例ACI患者的临床资料，根据术后发生颅内感染情况分为感染组(48例)和非感染组(32例)，根据3个月内预后情况分为预后不良组(23例)和非预后不良组(25例)，分析各组外周血黏附分子[黏附分子整合素αM(CD11b)、整合素β2(CD18)]及凝血功能指标[凝血酶原时间(prothrombin time，PT)、纤维蛋白原(fibrinogen，FIB)]的变化，采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价血清中CD11b、CD18、PT及FIB表达水平对ACI患者继发颅内感染诊断及预测预后的准确性。 结果 近期感染组的ACI患者CD11b、CD18、PT及FIB水平明显高于未感染组，差异有统计学意义(P＜0.05)。预后不良组的ACI患者CD11b、CD18、PT及FIB水平及显高于非预后不良组，差异有统计学意义(P＜0.05)。CD11b、CD18、PT及FIB诊断颅内感染的最佳诊断截点分别为18.060%、29.140%、13.235 s及4.600 g/L；四者联合诊断AUC面积为0.953，高于CD11b、CD18、PT及FIB的单一诊断(0.712、0.677、0.655及0.661)；四者联合诊断特异度为87.50%，高于单一诊断(71.43%、65.38%、60.07%及61.54%)；四者联合诊断灵敏度为91.67%，高于单一诊断(69.09%、72.22%、72.55%及70.37%)。 结论 外周血黏附分子及凝血功能指标对ACI术后近期颅内感染具有良好的诊断价值与一定的预后预测价值。Abstract: Objective To explore the value of peripheral blood adhesion molecules and coagulation function indexes in the diagnosis of recent intracranial infection and prognosis prediction in patients with acute cerebral infarction(ACI). Methods A retrospective analysis was performed on the clinical data of 80 patients with ACI admitted to the 731 Hospital of China Aerospace Science and Industry Corporation between June 2020 and June 2023. According to presence or absence of postoperative intracranial infection, they were divided into infection group(n=48) and non-infection group(n=32). According to the prognosis within 3 months, they were divided into poor prognosis group(n=23) and good prognosis group(n=25). The changes of peripheral blood adhesion molecules(adhesion molecule integrin αM[CD11b], integrin beta-2[CD18])and coagulation function indexes(prothrombin time[PT], fibrinogen[FIB])in different groups were analyzed. The accuracy of serum CD11b, CD18, PT and FIB in the diagnosis of secondary intracranial infection and prognosis prediction in ACI patients was evaluated by area under the receiver operating characteristic(ROC)area under the curve(AUC). Results The levels of CD11b, CD18, PT and FIB in infection group were significantly higher than those in non-infection group, and the difference was statistically significant(P < 0.05), and which were significantly higher in poor prognosis group than those in good prognosis group, and the difference was statistically significant(P < 0.05). The best cut-off values of CD11b, CD18, PT and FIB in the diagnosis of intracranial infection were 18.060%, 29.140%, 13.235 s and 4.600 g/L, respectively. AUC of combined detection was 0.953, greater than that of any single index(0.712, 0.677, 0.655, 0.661). The diagnostic specificity of combined detection was 87.50%, higher than that of any single index(71.43%, 65.38%, 60.07%, 61.54%). The diagnostic sensitivity of combined detection was 91.67%, higher than that of any single index(69.09%, 72.22%, 72.55%, 70.37%). Conclusion Peripheral blood adhesion molecules and coagulation function indexes have good diagnostic value for recent intracranial infection and therefore have certain predictive value for prognosis in ACI.
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表 1 两组一般情况比较
X±S 一般资料 感染组(48例) 未感染组(32例) χ2/t P 年龄/岁 60.51±9.77 61.64±7.08 0.563 0.575 性别/例(%) 0.134 0.714 男 25(52.08) 18(56.25) 女 23(47.92) 14(43.75) BMI/(kg/m2) 22.64±0.91 22.73±0.96 0.423 0.673 病史/例(%) 0.837 0.658 冠心病 16(33.33) 9(28.13) 高血压 20(41.67) 12(34.29) 糖尿病 12(25.00) 11(34.38) 脑梗部位/例(%) 0.034 0.854 左 22(45.83) 14(43.75) 右 26(54.17) 18(56.52) 脑疝/例(%) 10(20.83) 5(15.63) 0.342 0.559 接受溶栓/例(%) 17(35.42) 10(31.25) 0.149 0.699 DWI梗死面积/cm2 282.27±178.36 267.63±122.72 0.404 0.687 发病-手术时间/d 2.67±0.57 2.53±0.43 1.182 0.241 闭塞血管/例(%) 2.467 0.481 大脑中动脉 20(41.67) 16(50.00) 颈内动脉 18(37.50) 12(37.50) 大脑中动脉联合颈内动脉 9(18.75) 2(6.25) 其他动脉 3(6.25) 2(6.25) 机械通气/例(%) 39(81.25) 24(75.00) 0.555 0.456 
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表 2 两组外周血黏附分子及凝血功能指标比较
X±S 指标 感染组(48例) 未感染组(32例) t P CD11b/% 22.03±2.31 19.88±3.01 3.608 ＜0.001 CD18/% 33.64±3.24 28.59±3.55 6.573 ＜0.001 PT/s 14.82±1.22 12.87±1.21 7.026 ＜0.001 FIB/(g/L) 4.88±1.09 4.19±1.13 2.733 0.008
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表 3 不同预后情况的ACI患者外周血黏附分子及凝血功能指标比较
X±S 指标 预后不良组(23例) 非预后不良组(25例) t P CD11b/% 20.33±3.34 17.51±2.81 3.174 0.003 CD18/% 29.64±3.67 25.82±1.57 4.756 ＜0.001 PT/s 13.36±1.26 12.07±1.44 3.290 0.002 FIB/(g/L) 4.33±1.18 3.01±0.87 4.436 ＜0.001
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表 4 各指标单一及联合诊断颅内感染结果分析
血清指标 最佳截断值 AUC 特异度/% 灵敏度/% CD11b 18.060% 0.7121) 71.43 68.09 CD18 29.140% 0.6771) 65.38 72.22 PT/s 13.235 0.6551) 60.07 72.55 FIB/(g/L) 4.600 0.6611) 61.54 70.37 联合参数 - 0.953 87.50 91.67 与联合参数比较，1)P＜0.05。
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