血清CRP PA SAA及CRP/PA对老年脑卒中患者隐性吸入性肺炎的预测价值及与肺炎严重程度的关系

The predictive value of serum CRP,PA,SAA and CRP/PA monitoring to recessive aspiration pneumonia in elderly stroke patients and their relationships with

目的探讨血清C反应蛋白、前白蛋白、血清淀粉样蛋白A及C反应蛋白/前白蛋白比值对老年脑卒中患者隐性吸入性肺炎的预测价值及与肺炎严重程度的关系。方法对82例老年脑卒中患者临床资料进行回顾性分析,根据是否发生隐性吸入性肺炎分为无肺炎组42例和隐性吸入性肺炎组40例。比较入院后1 d、3 d、5 d及7 d两组患者血清C反应蛋白、前白蛋白、血清淀粉样蛋白A水平及C反应蛋白/前白蛋白比值的差异,绘制受试者特征(ROC)曲线评估其对隐性吸入性肺炎的预测价值。统计40例隐性吸入性肺炎患者肺炎严重程度(高危、中危、低危),比较肺炎不同严重程度患者血清上述指标,采用Pearson法分析血清各指标与肺炎严重程度的相关性。结果入院3 d两组患者血清C反应蛋白、血清淀粉样蛋白A水平比较差异有统计学意义(P<0.05);入院5 d、7 d隐性吸入性肺炎组血清C反应蛋白、血清淀粉样蛋白A水平及C反应蛋白/前白蛋白比值均高于无肺炎组,血清前白蛋白水平则低于无肺炎组,差异有统计学意义(P<0.05)。ROC曲线显示,入院5 d、7 d时上述指标联合检测的预测价值最高,曲线下面积(95%CI)分别为0.855(0.743~0.964)、0.873(0.802~0.943)。随着肺炎严重程度的升高,血清C反应蛋白、血清淀粉样蛋白A水平及C反应蛋白/前白蛋白比值呈上升趋势,血清前白蛋白水平呈下降趋势(P<0.05);Pearson相关分析显示,血清C反应蛋白、血清淀粉样蛋白A水平及C反应蛋白/前白蛋白比值与肺炎严重呈度指数呈显著正相关(P<0.05),血清前白蛋白水平与肺炎严重呈度指数呈显著负相关(P<0.05)。结论血清C反应蛋白、血清淀粉样蛋白A水平及C反应蛋白/前白蛋白比值持续异常上升,前白蛋白水平持续下降,可提示老年脑卒中患者隐性吸入性肺炎风险高;入院7 d血清指标联合评估脑卒中患者隐性吸入性肺炎的预测价值最高。

Objective To explore the predictive value of serum C-reactive protein(CRP),prealbumin(PA),serum amyloid A(SAA)and CRP to prealbumin ratio(CRP/PA)to recessive aspiration pneumonia(RAP)in elderly stroke patients and their relationships with pneumonia severity.Methods Clinical data of 82 elderly stroke patients were retrospectively analyzed,they were divided into non-pneumonia(n=42)and RAP(n=40)group according to whether they developed the RAP.Serum CRP,PA,SAA levels and CRP/PA on day 1,3,5 and 7 after admission were compared between two groups and the predictive values of the above indexes to the RAP assessed by drawing the Receiver Operating Characteristic(ROC)curve.Severities(high-,moderate-and low-risk)were counted,above-mentioned indexes compared among patients with different severities,and correlations of each serum indexes with the-severities of the RAP analyzed using Pearson method.Results Intergroup differences in serum CRP and SAA levels were statistically significant on day 3 after admission(P>0.05);serum CRP and SAA levels as well as CRP/PA were higher and PA lower in RAP than non-pneumonia group on day 5 and 7 after admission,differences were statistically significan(P<0.05).The ROC showed that the predictive value of combined above-mentioned indexes was the highest on day 5 and 7 after admission(P<0.05)and areas under the curve(95%CI)were respectively 0.855(0.743~0.964)and 0.873(0.802~0.943).Serum CRP,SAA and CRP/PA showed an upward trend and PA downward with the elevation of pneumonia severities(P<0.05);Pearson correlation analysis showed that serum CRP and SAA levels and CRP/PA were positively correlated with pneumonia severity index(PSI)and PA was negatively with the PSI(P<0.05).Conclusion The continuous abnormal increase of serum CRP and SAA levels and CRP/PA ratios and the continuous decrease of PA suggest that elderly stroke patients have a high risk of the RAP;the value of combined serum indexes predicting the RAP is the highest on day 7 after admission.