多种炎症标志物对卒中相关性肺炎的预测作用

Predictive Value of Multiple Inflammatory Markers in Stroke-associated Pneumonia

目的 评估多种炎症因子在急性缺血性脑卒中(AIS)患者并发卒中相关性肺炎(SAP)的预测价值。方法 回顾性选取2020年1月-2023年6月在哈尔滨医科大学附属第一医院住院治疗的236例AIS患者,根据住院7 d内是否发生SAP,将其分为SAP组56例(23.73%)和非SAP组180例(76.27%)。通过电子病历系统收集AIS患者的临床资料,采用多因素logistic回归法筛选老年AIS患者继发SAP的独立危险因素,采用ROC曲线评估各炎症指标预测SAP的临床价值。结果 与非SAP组比较,SAP组年龄>75岁、糖尿病、吞咽困难的比例以及中性粒细胞淋巴细胞比值(NLR)、全身免疫炎症指数(SII)、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)均升高,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄>75岁、吞咽困难、NLR、SII、CRP是老年AIS患者发生SAP的独立危险因素(P<0.05)。ROC曲线显示,NLR预测老年AIS患者发生SAP的AUC为0.833(95%CI:0.757~0.908),灵敏度为64.29%,特异度为99.44%,预测性能优于其他指标。结论NLR、SII、CRP均与老年AIS患者发生SAP相关,并在一定程度上预测SAP发生风险,其中NLR预测老年AIS患者发生SAP的效能最高,有助于辅助临床早期筛查出高风险人群并及时采取干预措施。

Objective To evaluate the predictive value of multiple inflammatory factors in patients with acute ischemic stroke(AIS)complicated by stroke-associated pneumonia(SAP).Methods A total of 236 AIS patients hospitalized in the First Affiliated Hospital of Harbin Medical University from January 2020 to June 2023 were retrospectively selected and divided into 56(23.73%)in the SAP group and 180(76.27%)in the non-SAP group according to whether SAP occurred within 7 days of hospitalization.The clinical data of AIS patients were collected by electronic medical record system.Multivariate logistic regression was used to screen the independent risk factors of secondary SAP in elderly AIS patients.ROC curve was used to evaluate the clinical value of each inflammatory index in predicting SAP.Results Compared with the non-SAP group,the proportions of age>75 years,diabetes mellitus,and dysphagia as well as the neutrophil to lymphocyte ratio(NLR),systemic immune-inflammation index(SII),C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)were elevated in the SAP group,and the differences were statistically significant(P<0.05).Multifactorial logistic regression analysis showed that age>75 years,dysphagia,NLR,SII,and CRP were independent risk factors for the development of SAP in elderly patients with AIS(P<0.05).ROC curves showed that the AUC of NLR for predicting SAP in elderly AIS patients was 0.833(95%CI:0.757-0.908),with a sensitivity of 64.29%and a specificity of 99.44%,and the prediction performance was better than other indicators.Conclusion NLR,SII,and CRP were all associated with the occurrence of SAP in elderly AIS patients and predicted the risk of SAP to a certain extent,among which NLR had the highest efficacy in predicting the occurrence of SAP in elderly AIS patients,which can help to assist the clinic in the early screening of high-risk populations and the timely adoption of intervention measures.