缺血性卒中超急性期患者血镁水平与卒中相关感染的相关性

Relationship between serum magnesium levels and stroke-associated infections in patients with ischemic stroke in the hyperacute phase

目的探讨缺血性卒中(ischemic stroke,IS)超急性期患者血镁水平与卒中相关感染(stroke associated infection,SAI)间的关联性。方法选取2022年1月至2023年1月安徽医科大学附属安庆第一人民医院神经内科IS超急性期患者108例作为研究对象,收集患者的临床资料,如性别、年龄、高血压、糖尿病、房颤、本次急诊血管内治疗等病史,记录入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分及确诊IS发病6h内的血镁水平及发病24h内其他实验室指标,根据入院后是否发生感染,将患者分为SAI组(n=37)和非SAI组(n=71),比较两组患者临床资料和实验室指标的差异。多因素Logistic回归分析IS患者并发SAI的独立影响因素,Pearson法分析血镁与其他影响因素之间的相关性。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析血镁对IS患者发生SAI的预测价值。结果SAI组患者通常年龄较大,心房颤动比例、接受血管内治疗的可能性、NIHSS评分、空腹血糖值高于非SAI组(P<0.05),而血镁、淋巴细胞计数和血小板计数低于非SAI组(P<0.05)。108例患者共19例出现低镁血症,多因素逐步Logistic回归分析显示血镁、年龄、NIHSS评分均为超急性期IS患者发生SAI的独立影响因素。Pearson分析显示超急性期IS患者血镁水平与NIHSS评分呈负相关(r=–0.233,P=0.015),而与年龄无相关性(P>0.05)。ROC曲线分析显示血镁预测患者发生SAI的曲线下面积为0.674(95%CI:0.567~0.781,P=0.003),最佳截断值0.80mmol/L,敏感度48.6%,特异性78.9%。结论超急性期IS患者合并低镁血症发生SAI的风险较高,血镁水平在一定程度上可作为超急性期IS患者发生SAI的预测指标。

Objective To investigate the potential association between serum magnesium levels and stroke-associated infections(SAI)in patients with hyperacute ischemic stroke(IS).Methods A total of 108 patients with hyperacute IS in the Neurology Department of Anqing First People’s Hospital of Anhui Medical University from January 2022 to January 2023 were selected.Clinical data such as gender,age,history of hypertension,diabetes,atrial fibrillation,and emergency endovascular treatment during this admission were collected.The National Institutes of Health stroke scale(NIHSS)score at admission,serum magnesium levels within 6 hours of IS onset,and other laboratory indicators within 24 hours of onset were recorded.Patients were divided into SAI group(n=37)and non-SAI group(n=71)based on whether they developed an infection after admission.Differences in clinical data and laboratory indicators between two groups were compared.Multivariate logistic regression analysis was conducted to identify the independent factors influencing the occurrence of SAI in IS patients,and the correlation between serum magnesium and other influencing factors was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum magnesium for SAI in IS patients.Results Patients in SAI group were generally older,had higher proportions of atrial fibrillation,were more likely to receive endovascular treatment,had higher NIHSS scores,and higher fasting blood glucose levels(P<0.05).Serum magnesium levels,lymphocyte counts,and platelet counts were significantly lower in SAI group compared to non-SAI group(P<0.05).Among the 108 patients,19 had hypomagnesemia.Multivariate Logistic regression analysis showed that serum magnesium,age,and NIHSS scores were independent factors associated with SAI in hyperacute IS patients.Pearson analysis showed that serum magnesium levels in hyperacute IS patients were negatively correlated with NIHSS scores(r=-0.233,P=0.015),but had no correlation with age(P>0.05).ROC curve analysis showed that the area under the curve for predicting SAI using serum magnesium was 0.674(95%CI:0.567-0.781,P=0.003),with an optimal cutoff value of 0.80 mmol/L,a sensitivity of 48.6%,and a specificity of 78.9%.Conclusion The risk of SAI with hyperacute IS patients with low magnesium lesions is high,and blood and magnesium levels can be used as predictive indicators of SAI for hyperacute IS patients.