血浆肝素结合蛋白水平对脑卒中相关性肺炎的诊断价值及其与患者短期预后的关系研究  

Diagnostic Value of Plasma Heparin Binding Protein Level in Stroke-associated Pneumonia and Its Relationship with Short-term Prognosis of Patients

作　　者：李花[1] 许济 LI Hua;XU Ji(Department of Neurology,3201 Hospital Affiliated to Medical College of Xi'an Jiaotong University,Xi'an 723000,China;Department of Rehabilitation Medicine,3201 Hospital Affiliated to Medical College of Xi'an Jiaotong University,Xi'an 723000,China)

机构地区：[1]西安交通大学医学院附属三二〇一医院神经内科,陕西省汉中市723000 [2]西安交通大学医学院附属三二〇一医院康复医学科,陕西省汉中市723000

出　　处：《实用心脑肺血管病杂志》2020年第8期69-73,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景脑卒中是一种因多种原因引起的脑血管受损疾病,具有较高的致残率和病死率。肝素结合蛋白(HBP)是一种多功能颗粒相关蛋白,与感染性疾病调控有关,在疾病进展中扮演着重要角色,有研究显示,血浆HBP对预测脑卒中相关性肺炎(SAP)患者预后具有积极作用。目的分析血浆HBP水平对SAP的诊断价值及其与患者短期预后的关系。方法选取2017年1月—2019年1月西安交通大学医学院附属三二〇一医院重症加强护理病房(ICU)收治的脑卒中患者135例,根据是否伴有SAP分为SAP组62例和非SAP组73例。比较两组患者一般资料,确诊第1、3、7天的血浆HBP、降钙素原(PCT)、C反应蛋白(CRP)水平,观察SAP组患者随访28 d的预后情况。绘制受试者工作特征曲线(ROC曲线)以评估血浆HBP、PCT、CRP水平对SAP的诊断价值。SAP患者预后的影响因素分析采用多因素Logistic回归分析。结果SAP组患者糖尿病发生率、有脑卒中病史者所占比例、美国国立卫生研究院卒中量表(NIHSS)评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、临床肺部感染评分(CPIS)高于非SAP组,格拉斯哥昏迷量表(GCS)评分低于非SAP组(P<0.05)。SAP组患者确诊第1天、第3天、第7天血浆HBP、PCT、CRP水平高于非SAP组(P<0.05)。ROC曲线显示,确诊第1天血浆HBP、PCT、CRP水平诊断SAP的ROC曲线下面积分别为0.919[95%CI(0.906,0.932)]、0.822[95%CI(0.725,0.919)]、0.808[95%CI(0.731,0.886)]。SAP患者随访28 d后生存33例,死亡29例。生存SAP患者确诊第1天血浆HBP、PCT、CRP水平低于死亡SAP患者(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分[OR=2.867,95%CI(1.159,7.091)]及确诊第1天血桨HBP[OR=3.927,95%CI(1.674,9.212)]、PCT[OR=4.391,95%CI(1.526,12.629)]、CRP[OR=4.723,95%CI(1.658,13.451)]水平是SAP患者短期预后的影响因素(P<0.05)。结论血浆HBP水平在SAP患者中较高,对SAP的诊断价值较高,且高血浆HBP水平是SAP患Background Stroke is a disease of cerebrovascular injury caused by many reasons,with a high disability and mortality.Heparin binding protein(HBP)is a multifunctional particle-related protein,related to the regulation of infectious diseases,plays an important role in disease progression,studies have shown that plasma HBP plays a positive role in predicting the prognosis of patients with stroke-associated pneumonia(SAP).Objective To analyze the diagnostic value of plasma HBP level in SAP and its relationship with short-term prognosis of patients.Methods A total of 135 stroke patients were enrolled in Intensive Care Unit(ICU)of 3201 Hospital Affiliated to Medical College of Xi’an Jiaotong University from January 2017 to January 2019,they were divided into SAP group(n=62)and non SAP group(n=73)according to whether there was SAP or not.General data,plasma levels of HBP,procalcitonin(PCT)and C-reactive protein(CRP)on the 1st,3rd and 7th day of diagnosis were compared between the two groups.Prognosis of the SAP group was observed after 28 days of follow-up.The ROC curve was drawn to observe the diagnostic value of plasma HBP,PCT and CRP levels in SAP.Multivariate Logistic regression analysis was used to analyze the influencing factors of short-term prognosis in SAP patients.Results Incidence of diabetes,stroke history,NIHSS score,APACHEⅡscore and CPIS in SAP group were statistically significantly higher than those in non SAP group,GCS score in SAP group was statistically significantly lower than that in non SAP group(P<0.05).Plasma levels of HBP,PCT and CRP in SAP group were statistically significantly higher than those in non SAP group on the 1st,3rd and 7th day of diagnosis(P<0.05).ROC curve showed that,the area under curve of plasma levels of HBP,PCT and CRP was 0.919[95%CI(0.906,0.932)],0.822[95%CI(0.725,0.919)],0.808[95%CI(0.731,0.886)]on the 1 st day of diagnosis,respectively.After 28 days of follow-up,33 patients survived and 29 died.Plasma levels of HBP,PCT and CRP in survived SAP patients were statistically

关 键 词：卒中 肺炎 脑卒中相关性肺炎 肝素结合蛋白 诊断 预后 

分 类 号：R743[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]