血清HBP和PTX3在重度脑损伤继发性肺部细菌性感染诊断中的应用价值

目的 探讨血清肝素结合蛋白（HBP）与正五聚蛋白3（PTX3）对重度脑损伤继发性肺部细菌性感染的诊断价值。方法 选择2015年3月至2019年1月我院重症医学科收治的重型颅脑损伤患者96例，对所有患者进行肺部感染情况判断，将出现继发性肺部细菌感染的患者纳入感染组，未出现继发性肺部细菌感染的患者纳入未感染组。分别检测两组患者入院后第1、3、5、7天的HBP、PTX3、白细胞（WBC）和C反应蛋白（CRP）水平，探讨其对于重度脑损伤患者继发肺部细菌感染的诊断价值，并对HBP、PTX3与WBC、CRP的相关性进行分析。结果 共有39例重度脑损患者纳入感染组，57例患者纳入未感染组，患者肺部细菌感染的发生率为40.6%。入院第1天感染组患者HBP、WBC及CRP水平明显高于未感染组，同时入院后第3、5、7天时感染组患者HBP、PTX3、WBC、CRP水平均显著高于未感染组，差异均具有统计学意义（均P<0.05）。单独采用HBP或PTX3对重度脑损伤继发性肺部细菌性感染进行诊断的约登指数为0.586和0.655，诊断的敏感性、特异性、阳性预测值、阴性预测值为74.3%、84.2%、76.3%、82.7%和79.5%、86.0%、79.5%、86.0%。联合检测的约登指数为0.776，诊断的敏感性、特异性、阳性预测值、阴性预测值为84.6%、93.4%、89.2%、89.8%。Spearman相关性分析显示HBP、PTX3水平与CRP水平均呈正线性相关（r=0.362、0.284，均P<0.05）。结论 HBP和PTX3均为重度脑损伤患者继发肺部细菌感染诊断的敏感指标，联合检测能够提高其检测价值，对重度脑损伤患者肺部感染的早期诊断具有一定临床意义。

Value of serum HBP and PTX3 in diagnosis of pulmonary bacterial infection secondary to severe brain injury

Abstract: Objective To explore the diagnostic value of serum heparin binding protein (HBP) and pentraxin 3 (PTX3) in pulmonary bacterial infection secondary to severe brain injury. Methods A total of 96 patients with severe craniocerebral injury admitted to our hospital from March 2015 to January 2019 were selected. The patients with secondary pulmonary bacterial infection were included in the infection group (n=39), while those without were included in the non-infection group (n=57). The levels of HBP, PTX3, WBC and CRP were detected on the 1st, 3rd, 5th and 7th day after admission. The relationship between the levels of HBP, PTX3, WBC and CRP and secondary lung bacterial infection was discussed. Results The incidence rate of secondary pulmonary bacterial infection was 40.6%. On the 1st day after admission, the levels of HBP, WBC and CRP in the infection group were significantly higher than those in the non-infection group. On the 3rd, 5th and 7th days, the levels of HBP, PTX3, WBC and CRP in the infection group were significantly higher than those in the non-infection group (all P<0.05). The Yoden index of diagnosis by using HBP vs PTX3 alone was 0.586 vs 0.655; The sensitivity, specificity, positive predictive value and negative predictive value of diagnosis were 74.3%, 84.2%, 76.3%, 82.7% vs 79.5%, 86.0%, 79.5% and 86.0%, respectively. The Yoden index of diagnosis by joint detection was 0.776, while the sensitivity, specificity, positive predictive value and negative predictive value of diagnosis were 84.6%, 93.4%, 89.2% and 89.8% respectively. Spearman correlation analysis showed that the levels of HBP and PTX3 were positively correlated with that of CRP (r=0.362, 0.284, all P<0.05). Conclusion Both HBP and PTX3 are sensitive indicators for the diagnosis of secondary pulmonary bacterial infections in patients with severe brain injury. The combined detection can improve the detection value and provide higher reference value for the early diagnosis of pulmonary infections in patients with severe brain injury.