缺血性脑卒中患者卒中相关性肺炎的发生与卒中后肠黏膜屏障功能损伤的关系

Relationship between ischemic stroke associated pneumonia and intestinal mucosal barrier dysfunction after stroke

目的探讨缺血性脑卒中患者发生卒中相关性肺炎(SAP)与卒中后肠黏膜屏障功能损伤之间的关系,以及血清二胺氧化酶(DAO)活性与D-乳酸(D-Lac)水平对SAP的预测价值。方法选取2018年6月—10月首次出现急性缺血性脑卒中并在徐州医科大学附属医院住院治疗的患者作为研究对象,共80例。根据缺血性脑卒中发病后48 h至7 d内是否发生SAP,将患者分为2组:SAP组(n=37)和非SAP组(n=43)。于发病后第1天、第2天、第7天采集患者外周静脉血,测定血清DAO活性、D-Lac水平。比较2组患者的一般资料、血清DAO活性和D-Lac水平;评估血清DAO和D-Lac对SAP的预测价值。结果与非SAP组相比,SAP组患者的年龄、糖尿病史、脑卒中面积、意识障碍、吞咽障碍、机械通气、鼻饲营养、GCS评分、NIHSS评分差异有统计学意义(P<0.05)。SAP组血清DAO活性在缺血性脑卒中后第1天、第2天高于非SAP组,而血清D-Lac水平在缺血性脑卒中后各时间点均高于非SAP组,差异有统计学意义(P<0.05)。同一组别不同时间点测量的DAO活性和D-Lac水平比较,差异有统计学意义(P<0.001),且血清DAO活性随时间逐渐降低,血清D-Lac水平逐渐升高。ROC曲线显示,脑卒中发病后第1天和第2天血清DAO曲线下面积(AUC)为0.711和0.687,特异度为82.9%和86.9%,灵敏度为61.9%和42.9%;D-Lac的AUC为0.845和0.736,特异度为82.9%和72.2%,灵敏度为83.3%和66.7%。结论缺血性脑卒中患者发生SAP与肠黏膜屏障受损有关;血清DAO活性、D-Lac水平对SAP具有预测价值,其中发病后第1天D-Lac水平的预测效能最优。

Objective To investigate the relationship between ischemic stroke associated pneumonia(SAP)and intestinal mucosal barrier dysfunction after stroke,and evaluate the predictive value of serum diamine oxidase(DAO)and d-lactate(D-Lac)levels for SAP.Methods A total of 80 patients who originally presented acute ischemic stroke from June 2018 to October 2018 and admitted in the Affiliated Hospital of Xuzhou Medical University were selected as subjects.According to the presence of SAP within 48 h to 7 d after onset of ischemic stroke,the patients were divided into two groups:a SAP group(n=37)and a non-SAP group(n=43).Peripheral venous blood samples were collected on Days 1,2,and 7 after onset,and the activity of serum DAO and D-Lac concentration were determined.The general information,serum DAO and D-Lac levels were compared between the two groups.The predictive value of DAO and D-Lac to SAP were evaluated.Results Compared with the non-SAP group,the SAP group showed remarkable differences in age,diabetes history,stroke area,disturbance of consciousness,dysphagia,mechanical ventilation,nasogastric nutrition,GCS score and NIHSS score(P<0.05).Significant increases were found in the SAP group as to the activity of serum DAO on Days 1 and 2 after ischemic stroke,and the level of serum D-Lac at each time point after ischemic stroke(P<0.05).The activity of DAO and level of D-Lac were statistically different in the same group at different time points(P<0.001).Moreover,the activity of serum DAO decreased but the level of serum D-Lac increased,along with the time.The ROC curve showed that the area under the curve(AUC)of serum DAO on Days 1 and 2 after stroke was 0.711 and 0.687,respectively,with a specificity of 82.9%and 86.9%,and a sensitivity of 61.9%and 42.9%.The AUC of D-Lac was 0.845 and 0.736,respectively,with a specificity of 82.9%and 72.2%,and a sensitivity of 83.3%and 66.7%.Conclusions The occurrence of SAP in patients with ischemic stroke is related to the damage of intestinal mucosal barrier.Serum DAO activity and D-Lac level are of predictive value for SAP,where D-Lac level is the most effective on Day 1 after stroke.