脑梗死后卒中相关性感染的危险因素

The analysis on the risk factors of infection after cerebral infarction

目的探讨脑梗死后卒中相关感染的危险因素。方法纳入急性脑梗死患者283例,根据是否感染分为非感染组(n=198)和感染组(n=85)。收集一般临床资料,于入院第1天和第7天测定血清皮质醇、血浆IL-4水平,分析卒中相关感染的危险因素。结果与非感染组相比,吸烟、机械通气、糖尿病、吞咽困难、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、意识水平、第1天皮质醇及IL-4升高、入院时平均美国国立卒中量表评分(the National Institutes of health stroke scale,NIHSS)、中面积及大面积脑梗死,大动脉粥样硬化及心源性脑梗死、左侧大脑半球、双侧大脑半球及幕下脑梗死脑梗死后感染发生率明显升高,两组统计学具有差异(P<0.05)。单因素及多因素Logistic回归分析发现:大面积脑梗死(OR=2.67)、COPD(OR=2.77)、入院第1天皮质醇升高(OR=3.26)、IL-4升高(OR=2.83)、左侧大脑半球脑梗死(OR=3.78)及幕下脑梗死(OR=3.12,)与卒中后感染显著相关(P<0.01),是脑卒中后感染的独立危险因素。结论免疫相关因子及不同区域脑梗死可能对卒中后感染的发生具有促进作用。

Objective To explore the risk factors of poststroke infection after cerebral infarction. Methods We consecutively included 283 patients with acute ischemic infarcts confirmed by diffusion-weighted imaging （DWI） within 72 hours from Guangxi stroke center. Based on infection status, patients were divided into Not infection group （n=198） and infection group （n=85）. The serum cortisol and plasma IL-4 were assessed using chemiluminescent system and double antibody sandwich enzyme linked immunosorbeut assay at admission and seventh day later, respectively. Results Compare to no infection group, smoking, mechanical ventilation, diabetes mellitus, dysphagia, COPD,level of consciousness, cortisol and IL-4 at admission, NIHSS, middle area and large area infarction, large atherosclerosis and cardiogenic infarction, left side ,both side and subtentorial infarction are more liable to infection （P〈0.05）;After a Single-factor and Multivariate analysis, we found that eortisol （OR 3.26） and IL-4 （OR 2.83）at admission, large area infarction （OR 2.67）,left side （OR 3.78）and subtentorial infarction （OR 3.12）were significant correlated with infection, suggesting that they might be the independent risk factors for infection after cerebral infarction. Conclusion Immunological factors and different regional cerebral infarction may increase susceptibility to infection after stroke.