老年卒中相关肺炎危险因素及血清PCT和PA与FIB的检测价值

Risk factors for stroke-associated pneumonia in elderly patients and value of serum PCT,PA and FIB

目的探究老年卒中相关肺炎(SAP)危险因素及血清降钙素原(PCT)、前白蛋白(PA)、纤维蛋白原(FIB)水平变化及其与病原微生物感染种类的关系。方法选取2019年3月-2021年3月屯昌县人民医院接收的106例老年SAP患者为病例组,同期诊治单纯老年卒中未合并任何感染的患者43例为对照组。检测所有患者确诊48 h内血清PCT、PA和FIB水平,应用Logistic回归法分析影响SAP发生的危险因素,分析SAP患者不同类别病原微生物感染与血清指标的相关性。结果Logisitic回归分析结果显示,年龄>70岁、吞咽困难、心力衰竭、使用质子泵抑制剂、神经功能缺损评分(NIHSS)>15分与SAP的发生密切相关,是老年脑卒中患者发生肺部感染的危险因素(P<0.05)。细菌感染组患者血清PCT和FIB均高于支原体感染组和病毒感染组,PA低于支原体感染组和病毒感染组(P<0.05)。受试者工作特征曲线(ROC)分析显示,血清PCT、PA、FIB联合预测SAP患者细菌感染的曲线下面积(AUC)为0.952,高于单独检测的0.859、0.832、0.871。结论年龄、吞咽困难、心力衰竭、使用质子泵抑制剂、NIHSS评分与SAP的发生密切相关,是老年脑卒中患者发生肺部感染的危险因素;细菌感染是老年SAP患者常见病原体,其次是病毒和支原体,联合血清PCT、PA和FIB有助于病原学诊断,指导临床用药。

OBJECTIVE To explore the risk factors for stroke-associated pneumonia(SAP)in elderly patients,observe the changes of levels of serum procalcitonin(PCT),prealbumin(PA)and fibrinogen(FIB),and analyze the association with the types of pathogenic microorganism infection.METHODS A total of 106 elderly patients with SAP who were treated in the Tunchang County People’s Hospital from Mar 2019 to Mar 2021 were assigned as the case group,meanwhile,43 elderly stroke patients who were not complicated with any infection were chosen as the control group.The levels of serum PCT,PA and FIB of all the patients were detected within 48 hours after diagnosis.Logistic regression analysis was performed for the risk factors for SAP,and the association between the type of pathogenic microorganism infection and the serological indexes was observed.RESULTS The result of logistic regression analysis showed that the more than 70 years of age,dysphagia,heart failure,use of proton pump inhibitors and National Institutes of Health Stroke Scale(NIHSS)score more than 15 points were closely associated with the incidence of SAP and were the risk factors for pulmonary infection in the elderly patients with stroke(P<0.05).The levels of serum PCT and FIB of the bacterial infection group were significantly higher than those of the mycoplasma infection group and the viral infection group,and the PA level of the bacterial infection group was significantly lower than that of the mycoplasma infection group and the viral infection group(P<0.05).Receiver operating characteristic(ROC)curve analysis indicated that the area under curve(AUC)of the joint detection of serum PCT,PA and FIB was 0.952 in prediction of bacterial infection in the SAP patients,higher than 0.859,0.832 and 0.871 of the single detection.CONCLUSION The age,dysphagia,heart failure,use of proton pump inhibitors and NIHSS score are closely associated with SAP and are the risk factors for the pulmonary infection in the elderly patients with stroke.The bacteria are dominant among the pathogens isolated from the elderly patients with SAP,followed by viruses and Mycoplasma.The joint detection of serum PCT,PA and FIB may facilitate the etiological diagnosis and provide guidance for clinical use of antibiotics.