缺血性卒中患者卒中相关性肺炎的预测：6种评分的比较  

Prediction of stroke-associated pneumonia in patients with acute ischemic stroke： comparison of 6 scores

作　　者：杭景[1] 潘希丁 戈念念 杨阳[1] 周俊山[1] 田有勇[1] Hang J;Ge NN;Yong Y;Zhou JS;Tian YY;Pan XD(Deportment of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210001, China;Deportment of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing 210001, China)

机构地区：[1]南京医科大学附属南京医院神经内科,210001 [2]南京医科大学附属南京医院药学部,210001

出　　处：《国际脑血管病杂志》2017年第11期972-978,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的 探讨Kwon评分、Chumbler评分、A2DS2（Age, Atrial fibrillation, Dysphagia, Sex, stroke Severity）评分、PANTHERIS（the Preventive ANtibacterial THERapy in acute Ischemic Stroke）评分、AIS-APS（Acute Ischemic Stroke-Associated Pneumonia Score）评分和ISAN（prestroke Independence, Sex, Age, NIHSS）评分对急性缺血性卒中患者卒中相关性肺炎（stroke-associated pneumonia, SAP）的预测价值。 方法 回顾性纳入急性缺血性卒中患者，根据是否并发SAP分组，比较SAP组与非SAP组之间的人口统计学和基线特征，采用多变量logistic回归分析确定SAP的独立危险因素。应用受试者工作特征（receiver operator characteristic, ROC）曲线比较6种评分对SAP的预测价值。 结果 共纳入1 427例缺血性卒中患者，卒中发病7 d内并发SAP 395例（27.7%）。SAP组年龄、性别、既往史（肺炎、心房颤动、吸烟）、实验室检查（白细胞计数〉11×109/L、基线血糖≥11.1 mmol/L）、牛津郡社区卒中项目（Oxfordshire Community Stroke Project, OCSP）分型、发病时被发现跌倒、吞咽障碍、机械通气、发病前改良Rankin量表（modified Rankin Scale, mRS）评分、基线格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分、基线美国国立卫生研究院量表（National Institutes of Health Stroke Scale, NIHSS）评分以及6种评分与非SAP组均存在显著统计学差异（P均〈0.05）。多变量logistic回归分析显示，年龄[优势比（odds ratio, OR） 1.034，95%可信区间（confidence interval, CI）1.019～1.049；P〈0.001]、白细胞计数〉11×109/L（OR 4.386，95% CI 2.763～6.905；P〈0.001）、基线血糖≥11.1mmol/L（OR 1.933，95% CI 1.305～2.864；P＝0.001）、吞咽障碍（OR 7.839，95% CI 4.892～12.563；P〈0.001）、基线NIHSS评分（OR 1.120，95% CI 1.077～1.165；P〈0.001）、基线GCS评分（OR 1.132，95% CI 1.019～1.257；P＝0.021）为发生SAP的独立危险因素。Chumbler评分、AIS-APObjective To investigate the predictive values of Kwon＇s score, Chumbler＇s score, Age, Atrial Fibrillation, Dysphagia, Sex, Stroke Severity （A2DS2） score, the Preventive ANtibacterial THERapy in Acute Ischemic Stroke （PANTHERIS） score, Acute Ischemic Stroke-Associated Pneumonia Score （AIS-APS）, and prestroke Independence, Sex, Age, NIHSS （ISAN） score for stroke-associated pneumonia （SAP） in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke were enrolled retrospectively. They were grouped according to whether to be complicated with SAP or not. The demography and baseline characteristics were compared between the SAP group and the non-SAP group. Multivariate logistic regression analysis was used to identify the independent risk factors for SAP. Receiver operating characteristic （ROC） curves were used to compare the predictive values of the 6 kinds of scores for SAP. Results A total of 1 427 patients with acute ischemic stroke were enrolled. Three hundred ninety-five patients （27.7%） complicated with SAP within 7 d after onset. There were significant differences in age, gender, past history （pneumonia, atrial fibrillation, smoking）, laboratory tests （white blood cell count 〉11×109/L, baseline blood glucose ≥11.1 mmol/L）, Oxfordshire Community Stroke Project （OCSP） classification, falling at the time of onset, dysphagia, mechanical ventilation and the modified Rankin Scale （mRS） score before onset, baseline Glasgow Coma Scale （GCS） score, baseline National Institutes of Health Stroke Scale （NIHSS） score and 6 scores between the SAP group and the non-SAP group （all P〈0.05）. Multivariate logistic regression analysis showed that age （odds ratio [OR] 1.034, 95% confidence interval [CI]1.019-1.049; P=0.001）, white cell count 〉11×109/L （OR 4.386, 95%CI 2.763-6.905; P=0.001）, baseline blood glucose≥11.1 mmol/L （OR 1.933, 95%CI 1.305-2.864; P=0.001）, dysphagia （OR 7.839, 95%CI 4.892-12.563; P=0.001）

关 键 词：卒中 脑缺血 肺炎 试验预期值 ROC曲线 危险性评估 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R743.3[医药卫生—内科学]