nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2019-8-1-18-29nmp-583Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПресепсин в диагностике нозокомиальной инфекции центральной нервной системыCerebrospinal Fluid Presepsin as a Marker of Nosocomial Infections of Central Nervous Systemhttps://orcid.org/0000-0002-6040-407XАбудеевС. А.AbudeyevS. A.

Абудеев Сергей Анатольевич – врач анестезиолог-реаниматолог

123098 Москва, ул. Маршала Новикова, д. 23

Sergey A. Abudeyev – Anesthesiologist

23 Marshala Novikova St., Moscow 123098

https://orcid.org/0000-0002-2667-6477КиселевК. В.KiselyovK. V.

Киселев Кирилл Владимирович – ассистент кафедры медицинской кибернетики и информатики

117997 Москва, ул. Островитянова, д. 1

Kirill V. Kiselyov – Assistant of the Department of Medical Cybernetics

1 Ostrovityanova St., Moscow 117997

https://orcid.org/0000-0003-2370-170XПариновО. В.ParinovO. V.

Паринов Олег Владимирович – кандидат медицинских наук, заместитель главного врача по терапии

123098 Москва, ул. Маршала Новикова, д. 23

Oleg V. Parinov  – Deputy Chief Physician for Therapy

23 Marshala Novikova St., Moscow 123098

https://orcid.org/0000-0002-9739-8478УдаловЮ. Д.UdalovYu. D.

Удалов Юрий Дмитриевич – кандидат медицинских наук, заместитель генерального директора по медицинской части

123098 Москва, ул. Маршала Новикова, д. 23

Yuri D. Uralov  – Deputy General Director for Medicine

23 Marshala Novikova St., Moscow 123098

https://orcid.org/0000-0001-9816-3614ЗабелинМ. В.ZabelinM. A.

Забелин Максим Васильевич – доктор медицинских наук, заместитель руководителя ФМБА России

123098 Москва, ул. Маршала Новикова, д. 23

 

Maksim V. Zabelin  – Dr. Med. Sci., Deputy Head

23 Marshala Novikova St., Moscow 123098

СамойловА. С.SamoylovA. S.

Самойлов Александр Сергеевич – доктор медицинских наук, генеральный директор

123098 Москва, ул. Маршала Новикова, д. 23

Aleksandr S. Samoylov – Dr. Med. Sci., General Director

23 Marshala Novikova St., Moscow 123098

https://orcid.org/0000-0002-6240-820XПопугаевК. А.PopugayevK. A.

Попугаев Константин Александрович – доктор медицинских наук, главный внештатный анестезиолог-реаниматолог ФМБА России, руководитель центра анестезиологии-реанимации и интенсивной терапии, заведующий отделением ФГБУ ГНЦ ФМБЦ им А.И. Бурназяна ФМБА России

123098 Москва, ул. Маршала Новикова, д. 23

Konstantin A. Popugayev – Dr. Med. Sci., Chief Externe Anesthesiologist of FMBA, Head of the Center of Anesthesiology, Resuscitation and Intensive Therapy, Head of the Department of the A.I. Burnazyan Federal Medical Biophysical Center

23 Marshala Novikova St., Moscow 123098

stan.popugaev@yahoo.comФГБУ «ГНЦ — ФМБЦ имени А.И. Бурназяна» ФМБАРоссияA.I. Burnazyan Federal Medical Biophysical Center, the Federal Medical & Biological Agency of Russian FederationRussian FederationГБОУ ВО «РНИМУ имени Н.И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov Russian National Research Medical university of the Ministry of Health of Russian FederationRussian FederationA.I. Burnazyan Federal Medical Biophysical Center, the Federal Medical & Biological Agency of Russian FederationRussian Federation201922042019811829Copyright © Абудеев С.А., Киселев К.В., Паринов О.В., Удалов Ю.Д., Забелин М.В., Самойлов А.С., Попугаев К.А., 20192019Абудеев С.А., Киселев К.В., Паринов О.В., Удалов Ю.Д., Забелин М.В., Самойлов А.С., Попугаев К.А.Abudeyev S.A., Kiselyov K.V., Parinov O.V., Udalov Y.D., Zabelin M.A., Samoylov A.S., Popugayev K.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/583

ВВЕДЕНИЕ Нозокомиальная инфекция центральной нервной системы (НИ ЦНС) является тяжелым осложнением, приводящим к ухудшению состояния, удлинению продолжительности лечения и ухудшению исходов заболевания у нейрореанимационных пациентов. Ранняя диагностика НИ ЦНС является актуальной клинической задачей, а поиск новых надежных маркеров НИ ЦНС — важной научной целью.

МАТЕРИАЛ И МЕТОДЫ Представленное исследование было проспективным и состояло из двух частей. Целью первой части было определить нормальный уровень пресепсина (ПСП) в спинномозговой жидкости (СМЖ). Для определения нормального уровня ПСП в СМЖ исследовались образцы ликвора, полученные при спинномозговой анестезии во время плановых урологических и общехирургических операций. Целью второй части было изучение динамики ПСП в СМЖ у различных групп нейрореанимационных пациентов в зависимости от наличия НИ ЦНС и системной инфекции. Вместе с ПСП в ликворе исследовали цитоз, уровень глюкозы, лактата, проводили его микробиологическое исследование и полимеразную цепную реакцию (ПЦР), когда это было возможно. Исследование крови включало в себя ее клинический анализ, определение содержания в ней С-реактивного белка (СРБ), прокальцитонина (PCT) и ПСП. Статистический анализ проводился с использованием IBM SPSS версии 23.0.

РЕЗУЛЬТАТЫ В первой части исследования для получения нормального уровня ПСП в СМЖ были исследованы 15 проб СМЖ у пациентов урологического или общехирургического профиля без поражения нервной системы. Уровень ПСП в СМЖ составил 50–100 пг/мл. Эти значения были приняты в качестве референсных для уровня ПСП в СМЖ в норме. Во второй части исследования были проанализированы 63 пары проб ликвора и крови у 19 нейрореанимационных пациентов. Все пары были разделены на 4 группы в соответствии с наличием в момент забора ликвора и крови НИ ЦНС и системной инфекции. При наличии НИ ЦНС и системной инфекции (группа 1) уровень ПСП в СМЖ составил 731,1±389,7 пг/мл. При отсутствии НИ ЦНС и наличии системной инфекции (группа 2) уровень ПСП в СМЖ составил 614,9±315 пг/мл. При наличии НИ ЦНС и отсутствии системной инфекции (группа 3) уровень ПСП в СМЖ составил 547,8±264,3 пг/мл. При отсутствии НИ ЦНС и системной инфекции (группа 4) уровень ПСП в СМЖ составил 406±203,1 пг/мл. ROC-анализ показал, что уровень ПСП в СМЖ выше 537 пг/мл у нейрореанимационных пациентов без системной инфекции означает наличие НИ ЦНС с чувствительностью 68,8% и специфичностью 85,7%.

ВЫВОДЫ В норме уровень пресепсина в ликворе составляет 50–100 пг/мл. Уровень пресепсина в ликворе выше 537 пг/мл у нейрореанимационного пациента без системной инфекции статистически значимо означает наличие у него НИ ЦНС. При диагностике НИ ЦНС определение уровня пресепсина в ликворе должно подлежать анализу вместе с традиционными маркерами инфекции ЦНС в качестве дополнительного маркера. Необходимо проведение дальнейших исследований.

ABSTRACT Introduction Nosocomial infection of the central nervous system (NI-CNS) is a serious complication in neurocritical patients that leads to deterioration of patient’s condition, worsening of outcomes and increased cost of treatment. The timely diagnosis of NI-CNS is a relevant problem and the search for new reliable markers of NI-CNS is an important issue.

MATERIAL AND METHODS The prospective observational study consisted of two parts. The aim of the frst part was to defne normal ranges of cerebral spinal presepsin (CSF PSP). The aim of the second part was investigation of CSF PSP in neurocritical patients. We studied CSF sampling obtained during spinal anesthesia for elective urologic surgery in order to defne the normal CSF PSP. The following data was collected in neurocritical patients: CSF cell count, glucose, lactate, PSP, microbiological tests, polymerase chain reaction (PCR), when it was possible. Blood tests included complete blood count, C-reactive protein (CRP), procalcitonin (PCT), PSP. IBM SPSS Statistics (version 23.0) was used for statistical analysis.

RESULTS Fifteen CSF samplings were obtained for investigation of normal CSF PSP ranges, which was 50–100 pg/ml. Nineteen neurocritical patients were included. Sixty-three pairs of CSF and blood samplings were obtained. All pairs were divided into the 4 groups in accordance with presence/absence of NI-CNS or systemic infection. In cases without both NI-CNS and systemic infection (group 4) CSF PSP was 406±203.1 pg/ml. In cases without NI-CNS and with systemic infection (group 2) CSF PSP was 614.9±315 pg/ml. In cases with NI-CNS and without systemic infection (group 3) CSF PSP was 547.8±264.3 pg/ml. In cases with both NI-CNS and systemic infection (group 1) CSF PSP was 731.1±389.7 pg/ml. The ROC analysis showed that in neurocritical patients without systemic infection CSF PSP 537 pg/ml meant NI-CNS with sensitivity 68.8% and specifcity 85.7%.

CONCLUSION The normal value of the CSF PSP is 50-100 pg/ml. CSF PSP more than 537 pg/ml in neurocritical patients without systemic infection meant NI-CNS with 688% sensitivity and 857% specifcity. CSF PSP may be used for diagnosing NI-CNS in neurocritical patients as an additional marker only. CSF may be used as an additional diagnostic criterion, but further research is needed.

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The authors declare that there are no conflicts of interest present.