Kim Jae-Hun, Ha Sang-Woo, Choi Jin-Gyu, Son Byung-Chul
Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Neurosurgery, Chosun University Hospital, Chosum University College of Medicine, Gwangju, Korea.
J Korean Neurosurg Soc. 2015 Oct;58(4):368-72. doi: 10.3340/jkns.2015.58.4.368. Epub 2015 Oct 30.
The occurrence of acute cerebral infection following deep brain stimulation (DBS) is currently being reported with elevation of C-reactive protein (CRP) level. The aim of the present study was to establish normal range of the magnitude and time-course of CRP increases following routine DBS procedures in the absence of clinical and laboratory signs of infection.
A retrospective evaluation of serial changes of plasma CRP levels in 46 patients undergoing bilateral, two-staged DBS was performed. Because DBS was performed as a two-staged procedure involving; implantation of lead and internal pulse generator (IPG), CRP was measured preoperatively and postoperatively every 2 days until normalization of CRP (post-lead implantation day 2 and 4, post-IPG implantation day 2, 4, and 6).
Compared with preoperative CRP levels (0.12±0.17 mg/dL, n=46), mean CRP levels were significantly elevated after lead insertion day 2 and 4 (1.68±1.83 mg/dL, n=46 and 0.76±0.38 mg/dL, n=16, respectively, p<0.001). The mean CRP levels at post-lead implantation day 2 were further elevated at post-IPG implantation day 2 (3.41±2.56 mg/dL, n=46, respectively, p<0.01). This elevation in post-IPG day 2 rapidly declined in day 4 (1.24±1.29 mg/dL, n=46, p<0.05) and normalized to preoperative value at day 6 (0.42±0.33 mg/dL, n=46, p>0.05). Mean CRP levels after IPG implantation were significantly higher in patients whose IPGs were implanted at post-lead day 3 than those at post-lead day 5-6 (3.99±2.80 mg/dL, n=30, and 2.31±1.56 mg/dL, n=16, respectively, p<0.05). However, there was no difference in post-IPG day 2 and 4 between them (p>0.05).
The mean postoperative CRP levels were highest on post-IPG insertion day 2 and decreased rapidly, returning to the normal range on post-IPG implantation day 6. The duration of post-lead implantation period influenced the magnitude of CRP elevation at post-IPG insertion day 2. Information about the normal response of CRP following DBS could help to avoid unnecessary diagnostic and therapeutic efforts.
目前有报道称，深部脑刺激（DBS）后会发生急性脑感染，同时伴有C反应蛋白（CRP）水平升高。本研究的目的是确定在没有感染的临床和实验室迹象的情况下，常规DBS手术后CRP升高的幅度和时间进程的正常范围。
对46例接受双侧、两阶段DBS的患者血浆CRP水平的系列变化进行回顾性评估。由于DBS是分两阶段进行的，包括植入电极和植入式脉冲发生器（IPG），因此在术前和术后每2天测量一次CRP，直至CRP恢复正常（电极植入后第2天和第4天、IPG植入后第2天、第4天和第6天）。
与术前CRP水平（0.12±0.17mg/dL，n = 46）相比，电极插入后第2天和第4天的平均CRP水平显著升高（分别为1.68±1.83mg/dL，n = 46和0.76±0.38mg/dL，n = 16，p<0.001）。电极植入后第2天的平均CRP水平在IPG植入后第2天进一步升高（分别为3.41±2.56mg/dL，n = 46，p<0.01）。IPG植入后第2天的这种升高在第4天迅速下降（1.24±1.29mg/dL，n = 46，p<0.05），并在第6天恢复到术前值（0.42±0.33mg/dL，n = 46，p>0.05）。IPG在电极植入后第3天植入的患者，其IPG植入后的平均CRP水平显著高于在电极植入后第5 - 6天植入的患者（分别为3.99±2.80mg/dL, n = 30和2.31±1.56mg/dL, n = 16，p<0.05）。然而，两者在IPG植入后第2天和第4天没有差异（p>0.05）。
术后平均CRP水平在IPG植入后第2天最高，并迅速下降，在IPG植入后第6天恢复到正常范围。电极植入后的持续时间影响IPG植入后第2天CRP升高的幅度。关于DBS后CRP正常反应的信息有助于避免不必要的诊断和治疗措施。
