降钙素原和T细胞亚群对急性脑梗死后相关性感染的预测价值

Role of procalcitonin and T lymphocytes subsets in predicting stroke-associated infection after acute ischemic stroke

目的探讨急性脑梗死后降钙素原（PCT）和T细胞亚群对脑卒中相关性感染（SAI）的预测价值。方法选取发病后36h内入院的首次急性脑梗死患者,根据起病7d内是否发生感染将患者分为SAI组64例和非SAI组68例,将2组相关指标比较后进行多因素logistic回归分析,对PCT、T细胞亚群指标绘制ROC曲线,评估其对SAI的预测价值。结果 SAI组脑桥梗死、美国国立卫生研究院卒中量表（NIHSS）评分高于非SAI组[32.8%vs16.2%、（14.8±5.6）分vs（10.4±3.9）分],差异有统计学意义（P〈0.05）;SAI组PCT高于非SAI组,差异有统计学意义（P=0.004）。SAI组CD4、CD8及CD4/CD8均低于非SAI组,差异有统计学意义（P〈0.05）;多因素logistic回归分析显示,脑桥梗死、NIHSS评分及PCT显著升高,CD4、CD8、CD4/CD8显著降低,差异有统计学意义（P〈0.05）;PCT曲线下面积为0.85（95%CI：0.48-0.89,P=0.004）,PCT＋CD4/CD8检测与其他单个指标比较,其曲线下面积为0.88（95%CI：0.71-0.97,P=0.004,）。结论脑梗死急性期通过联合检测患者PCT、T细胞亚群有助于预测SAI的发病风险。

Objective To study the role of procalcitonin（PCT）and T lymphocytes subsets in predicting stroke-associated infection（SAI）after acute ischemic stroke（AIS）.Methods One hundred and thirty-four AIS patients admitted to our hospital within 36 hours after onset of AIS were divided into SAI group（n=64）and non-SAI group（n=68）.The indications of SAI in two groups were analyzed by multivariate logistic regression analysis.ROC curves were plotted for PCT and T lymphocytes subsets and their value in predicting SAI was assessed.Results The incidence of ischemic stroke and the NIHSS score were significantly higher in SAI group than in non-SAI group（32.8%vs 16.2%,14.8±5.6 vs 10.4±3.9,P〈0.05）.The serum PCT level was significantly higher whereas the serum CD4 and CD8level and CD4/CD ratio were significantly lower in SAI group than in non-SAI group（P=0.004,P〈0.05）.Multivariate logistic regression analysis showed that the incidence of ischemic stroke and the NIHSS score were significantly higher and the serum CD4 and CD8level and CD4/CD ratio were significantly lower in SAI group than in non-SAI group（P〈0.05）.The area under the ROC curve for PCT was 0.85（95%CI：0.48-0.89,P=0.004）,and the area under the ROC curve for PCT＋CD4/CD8 was 0.88 when compared with the other single indication（95%CI：0.71-0.97,P=0.004）.Conclusion Detection of PCT and T lymphocytes subsets can predict the risk of SAI in AIS patients.