血清细胞因子预测急性脑梗死后肺炎的价值

Value of serum cytokines in predicting pneumonia secondary to acute cerebral infarction

目的研究血清细胞因子与急性脑梗死后肺炎发生的相关性并探讨其预测价值。方法选取在同济大学附属东方医院神经内科重症病房收治的99例急性脑梗死患者为研究对象,其中男性70例(70.71%),女性29例(29.29%);年龄27~95岁,平均(67±13)岁。发病48 h内检测血清十二项细胞因子浓度,包括白细胞介素(interleukin,IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P70,IL-17A,干扰素(interferon,IFN)-α,IFN-γ,肿瘤坏死因子(tumor necrosis factor,TNF)-α以及血清白蛋白、球蛋白、外周血白细胞计数、外周血淋巴细胞计数;依据研究对象其后是否发生肺炎分为肺炎组(44例)和非肺炎组(55例),应用二元Logistic回归分析明确十二项细胞因子是否为急性脑梗死后肺炎发生的独立预测因素。结果二元Logistic回归分析显示,血清IL-10浓度升高(OR 1.24,95%CI 1.01~1.52,P=0.039)和外周血白细胞计数增加(OR 1.50,95%CI 1.18~1.92,P=0.001)为急性脑梗死后肺炎的独立预测因素,发病48 h内血清IL-10>2.50ng/L预测急性脑梗死后肺炎的敏感度为61.36%,特异度为64.29%,外周血白细胞>10.00×109/L的敏感度为50.00%,特异度为81.48%,两者联合预测急性脑梗死后肺炎的敏感度为34.09%,特异度为83.33%。结论急性脑梗死早期血清IL-10升高和外周血白细胞计数增加有助于预测急性脑梗死后肺炎的发生,特异度较高、但敏感度较低。

Objective To investigate the correlation between serum cytokines and pneumonia secondary to acute cerebral infarction(ACI).Methods 99 patients with acute cerebral infarction admitted to the Neurology Intensive Care Unit of Dongfang Hospital Affiliated to Tongji University were selected as the study subjects,including 70 males(70.71%)and 29 females(29.29%);The age range is from 27 to 95 years old,with an average of(67±13)years old.Within 48 hours of onset,serum concentrations of twelve cytokines,including interleukin-1,were detectedβ,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P70,IL-17A,interferon(IFN)-α,IFN-γ,Tumor necrosis factor(TNF)-αAnd serum albumin,globulin,peripheral blood leukocyte count,peripheral blood lymphocyte count;According to whether the research subjects developed pneumonia afterwards,they were divided into pneumonia group(44 cases)and non pneumonia group(55 cases).Binary logistic regression analysis was used to determine whether the twelve cytokines were independent predictors of pneumonia after acute cerebral infarction.Results Binary logistic regression analysis showed that the increased serum IL-10(OR 1.24,95%CI 1.01-1.52,P=0.039)and increased peripheral blood WBC counts(OR 1.50,95%CI 1.18-1.92,P=0.001)were independent predictors for ACI secondary pneumonia.To predict ACI secondary pneumonia,the sensitivity and specificity of serum IL-10>2.50 ng/L within 48 hours of ACI,were 61.36%and 64.29%;the sensitivity and specificity of peripheral blood WBC counts>10.00×109/L within 48 hours of ACI,were 50.00%and 81.48%;the sensitivity and specificity of the combination of the two were 34.09%and 83.33%,respectively.Conclusion At the early stage of ACI,increased serum IL-10 and peripheral blood WBC counts have a certain diagnostic value for ACI secondary pneumonia,with high specificity but low sensitivity.