腔隙性脑梗死合并卒中相关性肺炎病原学及危险因素分析

Etiology and risk factors of lacunar infarction patients with stroke-associated pneumonia

目的:探讨腔隙性脑梗死(LI)合并卒中相关性肺炎(SAP)患者的病原学特点及危险因素。方法:回顾性分析2016年收治90例LI合并SAP患者(感染组)的临床资料,并通过医院病案抽样系统随机选取同期94例LI未合并SAP患者(对照组)的临床资料。结果:感染组痰标本检测出病原体27种,G^+菌、G^-菌、真菌分别占22.22%、62.96%、14.82%;检测出病原体113株,G^+菌、G^-菌、真菌分别占9.73%、65.49%、24.78%。与对照组相比,感染组血D-二聚体、超敏C反应蛋白(hs-CRP)、甘油三酯、高密度脂蛋白、载脂蛋白A、白蛋白、合并高血压和血脂代谢异常存在显著性差异(P<0.05或P<0.01)。多因素回归分析表明,2组间血清hs-CRP[OR=1.210,95%CI(1.059,1.383)]、合并高血压[OR=34.863,95%CI(2.151,565.057)]具有统计学差异(P<0.05或P<0.01)。结论:LI合并SAP患者致病菌主要为G-菌。血hs-CRP、合并高血压为LI合并SAP的独立危险因素。

Objective： To study the pathogenic characteristics and risk factors in lacunar infarction（ LI） patients with stroke-associated pneumonia（ SAP）. Methods： Ninty cases of SAP（ infected group） and 94 cases without SAP（ control group） in the same period were randomly selected through the hospital cases sampling system. The clinical data were retrospectively analyzed. Results： A total of 27 kinds of pathogens in infected group were detected,including gram positive bacilli（ 22. 22%）,gram negative cocci（ 62. 96%） and fungus（ 14. 82%）. And 113 strains were detected,including gram positive bacilli（ 9. 73%）,gram negative cocci（ 65. 49%） and fungus（ 24. 78%）. The univariate analysis showed there were statistically significant difference in D-Dimer,hyper-sensitive C-reactive protein（ hs-CRP）,triglycerides,high-density lipoprotein,apolipoprotein A,albumin,concomitant hypertension and dyslipidemia between two groups（ P〈0. 05 or P〈0. 01）.The results of multivariate logistic regression analysis indicated that hs-CRP [OR = 1. 210,95% CI（ 1. 059,1. 383） ]and concomitant hypertension [OR = 34. 863,95% CI（ 2. 151,565. 057） ] showed significant difference between two groups（ P〈0. 05 or P〈0. 01）. Conclusion： Pathogens in patients with LI and SAP were mainly gram negative bacteria. hs-CRP and concomitant hypertension are independent factors in LI patients with SAP.