神经功能、营养状况及运动能力量表评分与卒中相关肺炎风险关联性研究

Association of neurological function,nutritional status,and exercise capacity scale scores with risk of stroke related pneumonia

目的分析美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、老年营养风险指数(geriatric nutritional risk index,GNRI)、运动功能独立性评定(motor function independence measure,MFIM)评分与卒中相关性肺炎(stroke-related pneumonia,SAP)风险的关系。方法纳入2021年11月至2022年5月卒中入院的患者,收集入院时NIHSS、GNRI、MFIM评分,根据卒中发病后1周内是否发生肺炎分为SAP组和非SAP组。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析各评分最佳截断点并将评分转换为分类变量,采用多因素logistic回归模型和限制性立方样条分析各评分与SAP之间的关系。结果研究共纳入318例卒中患者,SAP组86例,非SAP组232例。logistic回归结果显示,NIHSS评分(OR=32.783,95%CI:16.366~65.671,P<0.001)、MFIM评分(OR=0.052,95%CI:0.027~0.100,P<0.001)和GNRI评分(OR=0.262,95%CI:0.144~0.476,P<0.001)与SAP存在关联。限制性立方样条分析显示,NIHSS评分(P_(总趋势)<0.001,P_(非线性)=0.002)、GNRI评分(P_(总趋势)<0.001,P_(非线性)<0.001)与SAP风险之间存在非线性剂量-反应关系。结论NIHSS、MFIM、GNRI评分和卒中患者SAP发生风险相关,其中NIHSS和GNRI评分与其存在非线性关联。

Objective To analyze the scores of National Institutes of Health stroke scale(NIHSS),geriatric nutritional risk index(GNRI),motor function in dependence measure(MFIM)and the risk of stroke-related pneumonia(SAP).Methods Patients with stroke admitted from November,2021 to May,2022 were included.The scores of NIHSS,GNRI and MFIM at admission were collected,and they were divided into non-SAP group(n=232)and SAP group(n=86)according to whether pneumonia occurred within one week after stroke.According to the receiver operating characteristic(ROC)curve,the predictive ability of each score to SAP was evaluated,and each score was grouped according to the best cut-off point.logistic regression model and restricted cubic spline were used to analyze the relationship between each score and SAP.Results A total of 318 stroke patients were enrolled in the study including 86 in SAP group and 232 in non-SAP group.Logistic regression shows that,levels of NIHSS score(OR=32.783,95%CI:16.366~65.671,P<0.001),MFIM score(OR=0.052,95%CI:0.027~0.100,P<0.001)and GNRI score(OR=0.262,95%CI:0.144~0.476,P<0.001)were associated with SAP.Restricted cubic spline analysis shows that,there was a nonlinear dose-response relationship between SAP risk and NIHSS score(P-general trend<0.001,P-nonlinear=0.002),GNRI score(P-general trend<0.001,P-nonlinear<0.001).Conclusion NIHSS,MFIM,and GNRI scores are associated with the risk of SAP in stroke patients,and some of them have nonlinear relationships.