A^2DS^2评分、降钙素原与C反应蛋白联合预测急性缺血性卒中患者的卒中相关性肺炎

Combination of A^2DS^2 score,procalcitonin and C-reactive protein predicts stroke-associated pneumonia in patients with acute ischemic stroke

目的探讨A^2DS^2评分、降钙素原(procalcitonin,PCT)和C反应蛋白(C-reactive protein,CRP)联合预测急性缺血性卒中患者卒中相关性肺炎(stroke-associated pneumonia,SAP)的价值。方法回顾性纳入2015年3月至2019年3月在南京鼓楼医院集团宿迁市人民医院神经内科住院就诊的急性缺血性卒中患者。应用多变量logistic回归分析确定A^2DS^2评分以及PCT和CRP水平与SAP的独立相关性。采用受试者工作特征(Receiver Operating Characteristic,ROC)曲线评估A^2DS^2评分、PCT和CRP水平对SAP的单独和联合预测价值。结果共纳入332例急性缺血性卒中患者,其中58例发生SAP(17.5%)。校正年龄、吸烟和高脂血症后,A^2DS^2评分[优势比(odds ratio,OR)1.613,95%可信区间(confidence interval,CI)1.092~2.389]、PCT(OR 8.047,95%CI 3.012~16.138)和CRP(OR 1.409,95%CI 1.064~2.672)均为发生SAP的独立预测因素。ROC曲线分析显示,A^2DS^2评分、PCT、CRP独立预测及三者联合预测SAP的曲线下面积分别为0.811、0.825、0.804和0.910。三者联合预测SAP的ROC曲线下面积显著高于单独预测(P均<0.001)。结论A^2DS^2评分、PCT和CRP三者联合可提高对SAP的预测能力。

Objective To investigate the value of combination of A^2DS^2 score,procalcitonin(PCT)and C-reactive protein(CRP)predicting stroke-associated pneumonia(SAP)in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Department of Neurology,Suqian People's Hospital of Nanjing Drum Tower Hospital Group from March 2015 to March 2019 were enrolled retrospectively.Multivariate logistic regression analysis was used to determine the independent correlation of A^2DS^2 scores as well as PCT and CRP levels with SAP.Receiver operating characteristic(ROC)curves were used to assess the individual and combined predictive values of A^2DS^2 scores,PCT and CRP levels for SAP.Results A total of 332 patients with acute ischemic stroke were enrolled,and 58 of them developed SAP(17.5%).After adjusting for age,smoking,and hyperlipidemia,the A^2DS^2 score(odds ratio[OR]1.613,95%confidence interval[CI]1.092-2.389),PCT(OR 8.047,95%CI 3.012-16.138)and CRP(OR 1.409,95%CI 1.064-2.672)were the independent predictors of SAP occurrence.ROC curve analysis showed that the area under the curve of A^2DS^2 score,PCT and CRP alone,and the combination of the three for predicting SAP were 0.811,0.825,0.804 and 0.910,respectively.When the three are jointly used to predict SAP,the area under the curve is significantly higher than the individual prediction(all P<0.001).Conclusions The combination of A^2DS^2 score,PCT and CRP can improve the ability to predict SAP.