血清CGRP和MMP-9与PCT对卒中相关肺炎的诊断价值

The diagnostic values of serum CGRP,MMP-9 and PCT in patients with stroke-associated pulmonary

目的分析血清降钙素基因相关肽(CGRP)、基质金属蛋白酶(MMP)-9、降钙素原(PCT)对卒中相关肺炎的诊断价值。方法选取2019年1月-2020年12月海南医学院第一附属医院神经内科收治的128例脑卒中患者为研究对象,根据是否发生肺部感染分为感染组72例和未感染组56例。对两组患者感染相关因素及入院时免疫功能指标、血清CGRP、MMP-9、PCT水平进行比较。结果感染组患者年龄、合并糖尿病例数、合并慢性阻塞性肺疾病例数及入院时美国国立卫生研究院卒中量表(NIHSS)评分均高于未感染组(P<0.05);感染组患者外周血CD_(4)^(+)T淋巴细胞比例、CD_(4)^(+)/CD_(8)^(+)T淋巴细胞比值和血清IgG、CGRP水平均低于未感染组,血清MMP-9、PCT水平均高于未感染组,两组之间的差异均有统计学意义(P<0.05);血清CGRP、MMP-9、PCT诊断脑卒中合并肺部感染的受试者工作特征(ROC)曲线下面积(AUC)分别为0.788、0.654、0.752(P<0.05),其中,血清CGRP的诊断灵敏度最高,为90.37%,血清PCT的诊断特异度最高,为89.29%,当将三者联合检测时,AUC提升至0.890(P<0.05)。结论脑卒中合并肺部感染与多种因素相关,患者的免疫功能损害更加显著,入院早期血清CGRP、MMP-9、PCT水平对于肺部感染具有辅助诊断价值,三者联合检测可提高诊断效率。

OBJECTIVE To analyze the diagnostic values of serum calcitonin gene related peptide(CGRP),matrix metalloproteinase(MMP)-9 and procalcitonin(PCT)in stroke patients complicated with pulmonary infection.METHODS A total of 128 stroke patients who were treated by neurology department of the First Affiliated Hospital of Hainan Medical College from Jan 2019 to Dec 2020 were selected as the study subjects,and were divided into the 72 cases of infection group and 56 cases of the non-infection group according to whether pulmonary infection occurred.The infection-related factors,immune function indexes,serum CGRP,MMP-9 and PCT levels at admission between the two groups of patients were compared.RESULTS The age,the proportion of diabetes mellitus,the proportion of chronic obstructive pulmonary disease and the National Institute of Health Stroke Scale(NIHSS)score of the patients in the infection group were significantly higher than those in the non-infection group(P<0.05).The percentage of peripheral blood CD_(8)^(+)T lymphocytes,the ratio of CD_(8)^(+)/CD_(8)^(+)T lymphocytes and the serum IgG,CGRP levels of the patients in the infection group were significantly lower than those of the non-infection group(P<0.05),the serum MMP-9 and PCT levels were significantly higher than those in the non-infection group(P<0.05).The areas under receiver operating characteristic curve(AUC)of serum CGRP,MMP-9 and PCT in diagnosis of stroke complicated with pulmonary infection were 0.788,0.654 and 0.752(P<0.05),respectively,among which,the diagnostic sensitivity of CGRP was the highest,which was 0.903,the diagnostic specificity of PCT was the highest,which was 0.892.When the three were tested in combination,AUC was increased to 0.890(P<0.05).CONCLUSION The incidence of stroke complicated with pulmonary infection was related to many factors,and the immune function damages of the patients were more significant.The serum CGRP,MMP-9 and PCT levels in early admission to hospital had auxiliary diagnostic values for pulmonary infections,and the combined detection of the three indexes could improve the diagnosis efficiency.