急性非重症卒中相关性肺炎危险因素分析  

Risk factors of stroke-associated pneumonia in patients with acute ischemic stroke

作　　者：黄敬 冯超 李俊雯 席刚明[1] 黄雨松 孙怡玮 HUANG Jing;FENG Chao;LI Jun-wen;XI Gang-min;HUANG Yu-song;SUN Yi-wei(Dept.of Neurology,Xuhui District Central Hospital,Shanghai 200031,China;Dept.of Cardiology,the Fourth Affiliated Hospital,Zhejiang University School of Medicine,Yiwu 322000,Zhejiang Province,China;Second Clinical Medical College,Wenzhou Medical University,Wenzhou 325035,Zhejiang Province,China)

机构地区：[1]上海市徐汇区中心医院神经内科,上海200031 [2]浙江大学医学院附属第四医院心内科,浙江义乌322000 [3]温州医科大学第二临床医学院,浙江温州325035

出　　处：《同济大学学报（医学版）》2020年第3期303-308,共6页Journal of Tongji University(Medical Science)

基　　金：上海市自然科学基金(19ZR1450100);徐汇区系统人才培养项目。

摘　　要：目的探讨急性缺血性脑卒中(acute ischemia stroke, AIS)患者非重症卒中相关性肺炎(stroke-associated pneumonia, SAP)的危险因素。方法 153例AIS患者分为SAP组(n=70)和非SAP组(n=83)。其中重症SAP患者45例。采用单因素分析法分别比较全部SAP患者及去除重症SAP患者后普通SAP患者与非SAP患者在吞咽困难、房颤、入院时NIHSS评分、常规生化指标、同型半胱氨酸、免疫抑制指标、血红蛋白、红细胞、凝血功能指标等的差异;采用多因素Logistic回归模型对有差异的指标进行分析,探讨SAP的危险因素。结果 2次单因素分析后显示存在吞咽障碍、房颤、NIHSS评分、肌红蛋白、肌钙蛋白I、B型钠尿肽、C反应蛋白、降钙素原、中性粒细胞数/淋巴细胞数、D-二聚体、纤维蛋白原与SAP的发生呈正相关,而白蛋白、淋巴细胞百分比、淋巴细胞计数、三酰甘油与SAP的发生呈负相关。多因素Logistic回归分析结果显示,吞咽障碍、房颤、淋巴细胞百分比减低、中性粒细胞数/淋巴细胞数增高、血脂减低是SAP发生的独立危险预测因素。结论 SAP是多因素介导的并发症,对于房颤患者及存在明显免疫抑制的患者需更多关注SAP的发生风险。Objective To investigate the risk factors of stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS).Methods One hundred and fifty-three patients with AIS were enrolled in the study,including 70 patients with SAP(SAP group)and 83 patients did not have SAP(non-SAP group).The SAP patients were further divided into severe SAP group(n=45)and non-severe SAP group(n=25).Univariate analysis was used to compare dysphagia,atrial fibrillation,NIHSS scale,ordinary biochemical items,homocysteine,immunosuppression,coagulation function between SAP group and non-SAP group,non-severe SAP group and non-SAP group.The multivariate logistic regression model was used to analyze the risk factors of SAP.Results Univariate analysis showed that SAP was positively correlated with dysphagia,atrial fibrillation,NIHSS score,myo-hemoglobin,troponin I,brain natriuretic polypeptide,C-reaction protein,procalcitonin,neutrophil/lymphocyte ratio,D-dimer,and fibrinogen;negatively correlated with albumin,lymphocyte percentage,lymphocyte count and triglycerides levels.Multivariate Logistic regression analysis showed that dysphagia,atrial fibrillation,deceased lymphocyte percentage,increased neutrophil/lymphocyte ratio and decreased blood lipid level were independent risk factors for SAP(P<0.05).Conclusion SAP after acute ischemic stroke is a multifactorial complication,more attention should be paid for patients with atrial fibrillation and immunosuppression.

关 键 词：脑梗塞 肺炎 危险因素 免疫抑制 房颤 

分 类 号：R446.11[医药卫生—诊断学]