血清C-反应蛋白联合T淋巴细胞亚群检测对脑卒中相关性感染的预测价值

Predictive Value of Serum C-reactive Protein Combined with T Lymphocyte Subsets in Stroke-associated Infection

目的 探讨血清C-反应蛋白(C-reactive protein, CRP)联合T淋巴细胞亚群检测对脑卒中相关性感染(stroke-associated infection, SAI)的临床预测价值。方法 选取2016年1月—2017年12月我院收治的148例脑卒中患者作为研究对象,根据有无SAI发生,分为SAI组与非SAI组。记录所有患者的临床资料,检测CRP和T淋巴细胞亚群(CD4、CD8、CD4/CD8)水平,经非条件多因素logistic回归分析影响SAI发生的相关危险因素,应用受试者工作特征(receiver operating characteristic curve, ROC)曲线分析CRP联合T淋巴细胞亚群检测预测SAI的临床价值。结果 本研究70例出现SAI,发生率为47.30%,其中肺部感染58例,泌尿系统感染12例。两组美国国立卫生研究院卒中量表(national institutes of health stroke scale, NIHSS)评分及病灶部位比较差异具有统计学意义( P <0.01)。与非SAI组比较,SAI组血清CRP水平升高,CD4、CD8及CD4/CD8水平均显著降低,差异具有统计学意义( P <0.01)。经非条件多因素logistic回归分析显示,脑桥损伤、NIHSS评分和CRP水平过高及CD4、CD8和CD4/CD8水平过低均为SAI发生的独立危险因素( P <0.05)。ROC曲线分析显示,CRP联合T淋巴细胞亚群检测预测SAI发生的灵敏度和特异度均较好,且曲线下面积最大,具有较好的预测价值。结论 CRP联合T淋巴细胞亚群检测预测SAI发生具有较高的灵敏度和特异度,可作为临床预测SAI发生的检查指标。

Objective To investigate the clinical predictive value of serum C-reactive protein (CRP) combined with T lymphocyte subsets in stroke-associated infection (SAI). Methods A total of 148 stroke patients admitted to our hospital from January 2016 to December 2017 were selected as the study subjects. According to the presence or absence of SAI, they were divided into SAI group and non-SAI group. The clinical data of all patients were recorded, and the levels of CRP and T lymphocyte subsets (CD4, CD8, and CD4/CD8) were measured. Unconditional multivariate logistic regression analysis was used to analyze the risk factors affecting the occurrence of SAI. The receiver operating characteristic curve (ROC) was used to analyze the clinical value of CRP combined with T lymphocyte subset for predicting SAI. Results In this study, SAI occurred in 70 stroke patients, and the incidence was 47.30%, including 58 cases with pulmonary infection and 12 cases with urinary tract infection.The difference in National Institutes of Health Stroke Scale (NIHSS) scores and lesion position were statistically significant between the two groups ( P <0.01). Compared with non-SAI group, serum CRP levels in SAI group were increased, while CD4, CD8 and CD4/CD8 levels were significantly lower, and the difference was statistically significant ( P <0.01). Unconditional multivariate logistic regression analysis showed that pontine injury, higher NIHSS score and CRP level, and lower CD4, CD8 and CD4/CD8 levels were independent risk factors for the development of SAI in stroke patients ( P <0.05). ROC curve analysis showed that CRP combined with T lymphocyte subset detection had better sensitivity and specificity for predicting the development of SAI in stroke patients, and the area under the curve was the largest, which had better predictive value. Conclusion CRP combined with T lymphocyte subset detection has high sensitivity and specificity for predicting the occurrence of SAI, which can be used as an indicator for clinical prediction of SAI occurrence.