A2DS2危险评分对缺血性卒中患者并发肺炎预测作用的临床研究

The clinical study of predictive effect of A2DS2 risk score on ischemic stroke associated pneumonia

目的探讨A2DS2危险评分模型对缺血性卒中患者并发肺炎的预测作用。方法采用回顾性研究方法，选择2010-12-2014-12我院神经科收治的缺血性卒中后并发肺炎患者202例（肺炎组），并随机选择同期神经科住院的缺血性卒中未并发肺炎患者202例作为对照（对照组）。比较两组患者临床特征（包括年龄、性别、住院时间、卒中程度、卒中部位、人院胃管进食、吞咽困难、既往病史、吸烟和饮酒史和出院预后）和实验室指标（包括血白细胞计数、中性粒细胞百分比、红细胞计数、血红蛋白、血糖）水平。运用Logistic回归分析缺血性卒中患者并发肺炎的相关危险因素，运用ROC曲线分析方法评价A2DS2危险评分对缺血性卒中后并发肺炎的预测作用。结果①单因素Logistic回归分析结果显示，两组年龄、卒中程度（NIHSS评分）、胃管进食、吞咽困难、右侧大脑半球卒中、小脑卒中及房颤差异有统计学意义（P〈0．01）；两组血白细胞计数、中性粒细胞百分比、红细胞计数、血红蛋白、血糖差异有统计学意义（P〈0．01）。多因素Logistic回归分析显示，高龄、入院胃管进食、吞咽障碍、意识障碍、右侧大脑半球卒中及血白细胞计数升高为缺血性卒中后并发肺炎的独立危险因素。②ROC曲线分析结果显示，A2DS2危险评分预测缺血性卒中后并发肺炎的C值（C-statistic）为0．893（95％C10．86-0．926），差异有统计学意义（P〈0．001）。结论A2DS2危险评分能有效地预测缺血性卒中后并发肺炎的风险。

Objective To analysis the predictive effect of A2DS2 risk score model on ischemic stroke associated pneumonia patients. Methods We selected 202 stroke associated pneumonia （SAP） patients that continuity hospiyalized from December 2010 to December 2014 in the Neurology Department of our hospital as case group, and then randomly chose the same number patients of non - pneumonia after stroke as control group. Comparing the difference of patientsclinical characteristics （age, gender, hospital stays, the severity of stroke,lesion location, gastric tube feeding on admission, dysphagia, existing disease, smoking and drinking, prognosis at discharge ）and laboratory results （blood routine examination, emergency biochemistry tests）. The logistic regression analysis was used to analyze the related factors of ischemie stroke associated pneumonia. Then, we use receiver operating characteristic curve to evaluate the predictive effect of A2DS2 risk score for ischemie stroke asscoiated pneumonia. Results （1）UnivariateLogistie regression analysis shows that there was statistically significant difference betweenthe two groups of the levels of age, hospital stays, stroke severity（ NIHSS score）, gastric tube feeding, dysphagia, the right cerebral hemisphere stroke, cerebellar stroke, atrial fibrillation and the levels of WBC, neutrophils percentage, hemoglobin, and the levels of lymphocytes percentage, RBC, hemoglobin just the opposite （P 〈 0. 05 ） ;there was no obvious difference in the levels of blood platelet between two groups（P 〉 9. 05 ）. （2）The results of receiver operating characteristic curve showed that predictive C - statistic of A2DS2 risk score for ischemic stroke associated pneumonia was 0. 893 （ 95% CI 0. 86 0. 926 ） ,which had remarkable statistial significance meaning （ P 〈 0. 001 ）. Conclusion A2DS2 risk score provides an effective method for prediction of the risk of ischemic stroke associated pneumonia.