Abstract
Objective:Intracranial infection in neurology patients is associated with high mortality and disability rates,and early diagnosis remains highly challenging,underscoring the need for sensitive and specific early biomarkers.Heparin-binding protein(HBP)mediates blood-brain barrier injury and inflammatory cascade reactions,while T lymphocyte subsets reflect specific immune responses.Together,they play critical roles in the pathogenesis of intracranial infection;however,the value of their combined application remains unclear.This study aims to investigate the predictive value of T lymphocyte subsets combined with HBP for intracranial infection and their association with prognosis.
Methods:This retrospective study included patients with suspected intracranial infection who were treated in the Department of Neurology,Nanyang Second People's Hospital,between January 2023 and April 2025.According to comprehensive clinical diagnosis,patients with confirmed intracranial infection were assigned to the intracranial infection group,while those without intracranial infection served as controls.Based on the Glasgow Outcome Scale(GOS)score at 3 months after treatment,patients with intracranial infection were further divided into a favorable prognosis group(GOS score 4 to 5)and an unfavorable prognosis group(GOS score 1 to 3).Blood and cerebrospinal fluid(CSF)samples were collected from all patients within 24 hours of admission.Peripheral blood T lymphocyte subsets,including CD3+,CD4+,and CD8+T cells,were measured by flow cytometry,and the CD4+/CD8+ratio was calculated.Complete blood count and serum high-sensitivity C-reactive protein(hs-CRP)levels were determined.CSF inflammatory markers,including HBP,interleukin(IL)-1β,IL-2 receptor,IL-6,and IL-8,were measured using enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was performed to evaluate the effects of peripheral blood T lymphocyte subsets and CSF HBP on the risk of intracranial infection and unfavorable prognosis.Univariate analyses were conducted first,and variables showing statistical significance were subsequently entered into multivariate logistic regression models to identify independent risk factors.Receiver operating characteristic(ROC)curves were generated,and the area under the curve(AUC)was calculated to assess the diagnostic and prognostic performance of each indicator.To evaluate the value of combined diagnosis,a multivariate Logistic regression-based prediction model was established using independent factors identified in the multivariate analysis.Predicted probabilities were calculated for each patient and used as test variables to generate combined ROC curves,which were compared with AUCs of individual markers.
Results:A total of 96 patients were included in the intracranial infection group and 35 in the control group.Among patients with intracranial infection,38 had an unfavorable prognosis,and 58 had a favorable prognosis.Compared with the control group,patients with intracranial infection had significantly lower peripheral blood CD3+and CD4+levels and a lower CD4+/CD8+ratio,whereas peripheral blood CD8+levels and cerebrospinal fluid(CSF)HBP levels were significantly higher(all P<0.05).Elevated peripheral blood CD3+(OR=0.849)and CD4+(OR=0.828)levels were identified as independent protective factors against intracranial infection,whereas elevated peripheral blood CD8+(OR=1.489)and CSF HBP(OR=1.189)levels were independent risk factors(all P<0.05).ROC curve analysis showed that the combined detection of peripheral blood CD3+,CD4+,CD8+,and CSF HBP achieved significantly better diagnostic performance for intracranial infection(AUC=0.962)than any single indicator alone(AUCs of 0.812,0.827,0.750,and 0.866,respectively),with a sensitivity of 88.54％and a specificity of 91.43％.For differentiating viral from bacterial infections,the combined model also demonstrated superior performance(AUC=0.883)compared with individual markers(AUCs of 0.761,0.774,0.693,and 0.799,respectively).Compared with the favorable prognosis group,the unfavorable prognosis group had significantly higher CSF HBP levels and significantly lower serum CD4+levels and CD4+/CD8+ratios(all P<0.05).Reduced CD4+/CD8+ratio(OR=0.175)and elevated CSF HBP level(OR=1.095)were independent predictors of unfavorable prognosis(both P<0.05).ROC curve analysis showed that the combined application of these 2 indicators increased the AUC for predicting unfavorable prognosis to 0.809,which was significantly higher than that of either indicator alone(AUCs of 0.674 and 0.730,respectively).
Conclusion:The combination of T lymphocyte subsets and CSF HBP significantly improves the diagnostic accuracy and etiological differentiation of intracranial infection and provides substantial value in predicting unfavorable prognosis.This combined approach has promising clinical application prospects.关键词
T淋巴细胞亚群/脑脊液/肝素结合蛋白/颅内感染/诊断价值/预后Key words
T lymphocyte subsets/cerebrospinal fluid/heparin-binding protein/intracranial infection/diagnostic value/prognosis分类
医药卫生
