血清NGAL、GLI及NLR对脑卒中并发肺部感染患者预后的预测价值分析

The Predictive Value Analysis of Serum NGAL,GLI and NLR in Prognosis of Patients with Stroke Complicated with Pulmonary Infection

目的:探究血清中性粒细胞明胶酶相关脂质蛋白(NGAL)、血糖不稳定指数(GLI)、中性粒细胞与淋巴细胞比值(NLR)对脑卒中并发肺部感染患者预后的预测价值。方法:选取2020年10月-2022年6月我院收治的98例脑卒中并发肺部感染患者,随访3个月,根据预后分为预后良好组67例与预后不良组31例,比较两组临床资料、实验室指标及血清NGAL、GLI、NLR水平,分析NGAL、GLI、NLR与临床肺部感染评分(CPIS)、美国国立卫生研究院卒中量表(NIHSS)评分、急性缺血性卒中相关性肺炎评分(AIS-APS)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞(WBC)计数的相关性,多因素Logistic回归分析脑卒中并发肺部感染患者预后不良的影响因素,受试者工作特征曲线(ROC)分析NGAL、GLI、NLR单独预测及联合预测脑卒中并发肺部感染患者预后不良的价值。结果:预后不良组住院时间、空腹血糖、CPIS评分、AIS-APS评分、NIHSS评分、TNF-α、hs-CRP、WBC显著高于预后良好组(P<0.05)。预后不良组血清NGAL、GLI、NLR、中性粒细胞计数显著高于预后良好组(P<0.05),淋巴细胞计数显著低于预后良好组(P<0.05)。NGAL、GLI、NLR与CPIS评分、AIS-APS评分、NIHSS评分、TNF-α、hs-CRP、WBC均呈正相关(P<0.05)。高NGAL、GLI、NLR、CPIS评分、NIHSS评分、TNF-α为脑卒中并发肺部感染患者预后不良的危险因素(P<0.05)。NGAL、GLI、NLR联合预测脑卒中并发肺部感染患者预后不良的AUC为0.864,其价值显著优于各项指标单独检测(P<0.05)。结论:血清NGAL、GLI、NLR在脑卒中并发肺部感染预后不良患者中升高较为显著,三者联合对于脑卒中并发肺部感染患者预后不良有较好的预测价值。

Objective:To explore the predictive value of serum neutrophil gelatinase-associated lipocalin(NGAL),glycemic lability index(GLI),neutrophil to lymphocyte ratio(NLR)in prognosis of patients with stroke complicated with pulmonary infection.Methods:98 patients with stroke complicated by pulmonary infection who were admitted to our hospital from October 2020 to June 2022 were selected,and followed up for 3 months.According to the prognosis,they were divided into good prognosis group with 67 cases and poor prognosis group with 31 cases.Clinical data,laboratory indexes and serum NGAL,GLI and NLR levels were compared between the two groups.The correlation between NGAL,GLI,NLR and clinical pulmonary infection score(CPIS),National Institutes of Health Stroke Scale(NIHSS)score,acute ischemic stroke associated pneumonia score(AIS-APS),tumor necrosis faction-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),white blood cell(WBC)count were analyzed.Multivariate Logistic regression analysis was used to analyze the influencing factors of the poor prognosis of patients with stroke complicated by pulmonary infection,and receiver operating characteristic curve(ROC)was used to analyze the value of NGAL,GLI and NLR alone and combined in predicting poor prognosis of patients with stroke complicated with pulmonary infection.Results:The hospitalization time,fasting blood glucose,CPIS score,AIS-APS score,NIHSS score,TNF-α,hs-CRP and WBC in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).Serum NGAL,GLI,NLR and neutrophil count in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05),while lymphocyte count was significantly lower than that in the good prognosis group(P<0.05).NGAL,GLI and NLR were positively correlated with CPIS score,AIS-APS score,NIHSS score,TNF-α,hs-CRP and WBC(P<0.05).High NGAL,GLI,NLR,CPIS score,NIHSS score and TNF-α were risk factors for poor prognosis in patients with stroke complicated with pulmonary infection(P<0.05).The AUC of the combination of NGAL,GLI and NLR in predicting poor prognosis of patients with stroke complicated with pulmonary infection was 0.864,which was significantly better than that of each index alone detection(P<0.05).Conclusion:Serum NGAL,GLI,and NLR increased significantly in patients with stroke complicated with pulmonary infection with poor prognosis,and the combination of the three has good predictive value for the poor prognosis of patients with stroke complicated with pulmonary infection.