外周血炎症标志物对急性缺血性脑卒中相关性肺炎的预测价值

Predictive Value of Peripheral Blood Inflammatory Markers for Acute Ischemic Stroke-associated Pneumonia

目的探讨外周血炎症标志物对急性缺血性脑卒中(AIS)患者发生脑卒中相关性肺炎(SAP)的预测价值。方法回顾性纳入郑州市中心医院收治的50例AIS合并SAP患者(SAP组)和同期收治的50例无合并SAP的AIS患者(非SAP组)进行病例对照研究。收集患者的临床资料及外周血炎症指标:全身免疫炎症指数(SII)、中性粒细胞/淋巴细胞比值(NLR)、衍生中性粒细胞/淋巴细胞比值(dNLR)、淋巴细胞/单核细胞比值(LMR)和血小板/淋巴细胞比值(PLR)。应用Pearson相关分析上述指标与AIS-APS评分的相关性;多因素Logistic回归分析筛选发生SAP的独立危险因素;ROC曲线评价炎症标志物对SAP的预测价值;Kaplan-Meier曲线评价炎症指标对SAP发生的影响。结果SAP组SII、NLR、dNLR、PLR水平均明显高于非SAP组,而LMR水平低于非SAP组(均P<0.05);外周血炎症指标与AIS-APS评分密切相关(P<0.05)。高龄、NIHSS量表评分高,SII和PLR高水平是AIS发生SAP的独立危险因素。SII和PLR对SAP发生的预测能力与AIS-APS评分相仿,其ROC曲线的AUC值分别为0.757、0.626、0.757。SII与PLR联合预测对发生SAP的预测价值较单独指标更高(AUC值0.860)。SII和PLR高水平的AIS患者更易发生SAP。结论SII、PLR对SAP的发生具有预测价值,两者联合的预测价值较单独预测指标高。

Aim To investigate the predictive values of peripheral blood inflammatory markers for stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS).Methods A casecontrol study was performed including 50 cases of AIS with SAP,and 50 cases of AIS without SAP.The clinical data and peripheral blood inflammatory indicators,including systemic immune inflammatory index(SII),neutrophil to lymphocyte ratio(NLR),derived neutrophil to lymphocyte ratio(dNLR),lymphocyte to monocyte ratio(LMR)and platelet to lymphocyte ratio(PLR)were systematically collected.Pearson correlation analysis was used to analyze the correlation between inflammatory indicators and acute ischemic stroke-associated pneumonia score(AIS-APS),multivariate Logistic regression analysis was used to screen independent risk factors for SAP,receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the above inflammatory markers on SAP,and the Kaplan-Meier curve was used to evaluate the effect of the corresponding inflammatory markers on the occurrence of SAP.Results The values of SII,NLR,dNLR and PLR in the SAP group were significantly higher than those in the non-SAP group,and the LMR value was lower than that in the non-SAP group(P<0.05).Peripheral blood inflammatory indicators correlated significantly to AIS-APS(P<0.05).Elder age,higher National Institutes of Health Stroke Scale(NIHSS),higher SII and PLR values were independent risk factors for SAP in patients with AIS.The predictive abilities of SII and PLR to the occurrence of SAP were similar to that of AIS-APS score,with AUC values of 0.757,0.626,and 0.757.The predictive value of the combination of SII and PLR for the occurrence of SAP was much,with its AUC value of 0.860.Patients in the higher SII group and higher PLR group were more likely to develop SAP.Conclusion Peripheral SII and PLR values were predictive for SAP,and the combination of SII and PLR showed a much higher predictive effects.