血栓炎症预后评分对老年脑卒中相关肺炎的预测价值

Predictive value of thrombo-inflammatory prognostic score in the elderly with stroke-associated pneumonia

目的 探讨血栓炎症预后评分(TIPS)对急性缺血性脑卒中(AIS)患者脑卒中相关肺炎(SAP)的预测价值。方法 回顾性纳入2018年6月1日~2019年6月30日四川大学华西医院急诊科救诊的AIS患者277例,根据TIPS分为0分组78例、1分组96例和2分组103例,行TIPS和脑卒中严重程度(A~2DS~2)评分。用多因素logistic回归分析SAP的危险因素。结果 TIPS 0分组、1分组和2分组SAP发生率(12.8%vs 26.0%vs 68.0%)、住院时间[(8±2)d vs(10±2)d vs(11±2)d]及随访期间病死率(5.1%vs 16.7%vs 23.3%)比较,有统计学差异(P<0.01)。TIPS 1~2分与SAP发病率独立相关(P<0.05,P<0.01)。TIPS和A~2DS~2评分预测SAP的曲线下面积分别为0.776(95%CI:0.725~0.826,P<0.01)和0.754(95%CI:0.699~0.807,P<0.01),TIPS的曲线下面积明显优于A~2DS~2评分(P<0.01)。结论 TIPS预测AIS患者SAP价值高,可以早期识别SAP高风险患者。

Objective To explore the predictive value of TIPS in AIS patients for SAP.Methods The clinical data of 277 patients with acute ischemic stroke who were treated in the emergency department of West China Hospital of Sichuan University from June 2018 to June 2019 were collected and retrospectively analyzed.According to TIPS score, they were divided into TIPS score 0(n=78),1(n=96),and 2(n=103) groups.A~2DS~2(age, atrial fibrillation, dysphagia, sex, stroke severity) score was also evaluated.Multivariate logistic regression analysis was used to analyze the risk factors of SAP.Results Among the patients with TIPS scores 0,1 and 2,the incidence of SAP was 12.8%,26.0% and 68.0% respectively, the length of hospital stay was 8±2,10±2 and 11±2 d, and the mortality during follow-up was 5.1%,16.7% and 23.3%,respectively, with statistical differences(P<0.01).TIPS scores 1 and 2 were independent predictors of SAP(P<0.05,P<0.01).The AUC values of TIPS and A~2DS~2 scores in predicting SAP was 0.776(95%CI:0.725-0.826,P<0.01) and 0.754(95%CI:0.699-0.807,P<0.01),and the predictive efficacy was better in TIPS score(P<0.01).Conclusion TIPS score has better value in predicting SAP in AIS patients, and can early identify SAP high-risk patients.