血清白细胞介素33对急性缺血性卒中患者并发卒中相关性肺炎的预测价值  

Predictive value of serum interleukin-33 for stroke-associated pneumonia in patients with acute ischemic stroke

作　　者：陈祯蕾 胡庆哲 霍颖超 张融融[1] 吴燕平 秦新月[1] Chen Zhenlei;Hu Qingzhe;Huo Yingchao;Zhang Rongrong;Wu Yanping;Qin Xinyue(Department of Neurology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经内科,400016

出　　处：《中国脑血管病杂志》2020年第11期655-660,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨血清白细胞介素33(IL-33)与卒中相关性肺炎的关系及其对急性缺血性卒中患者并发卒中相关性肺炎的预测价值。方法回顾性连续纳入2019年3—10月于重庆医科大学附属第一医院神经内科接受住院治疗的140例急性缺血性卒中患者。根据患者入院48 h内是否并发卒中相关性肺炎,将140例急性缺血性卒中患者分为肺部感染组(39例)与无肺部感染组(101例)。收集并分析两组患者的基线及临床资料,基线资料包括性别、年龄、脑血管病危险因素;临床资料包括美国国立卫生研究院卒中量表(NIHSS)评分、IL-33浓度及NIHSS评分>14分、侵入性操作(留置胃管、留置尿管、气管切开等)比例。采用酶联免疫吸附测定检测血清中IL-33的浓度,通过受试者工作特征(ROC)曲线及曲线下面积(AUC)评估IL-33对缺血性卒中并发卒中相关性肺炎的预测价值。以卒中相关性肺炎为因变量,纳入单因素分析中的变量(P<0.05)进一步对并发卒中相关性肺炎的影响因素行多因素Logistic回归分析。结果(1)两组患者高血压病、糖尿病、高脂血症、冠心病、吸烟、男性比例及年龄的差异均无统计学意义(均P>0.05)。(2)肺部感染组NIHSS评分>14分、侵入性操作的比例均高于无肺部感染组[分别为53.8%(21/39)比18.8%(19/101),χ2=16.922;51.3%(20/39)比6.9%(7/101),χ2=35.554],IL-33浓度、NIHSS评分均高于无肺部感染组[分别为92.1(72.4,144.5)ng/L比63.4(45.2,80.9)ng/L,Z=-5.199;15.0(11.0,27.0)分比3.0(2.0,8.5)分,Z=-6.036],组间差异均有统计学意义(均P<0.01)。(3)经ROC曲线分析,IL-33的AUC为0.784(95%CI:0.697~0.871,P<0.01)时,约登指数为0.492,最佳截断值为74.4 ng/L,其敏感度和特异度分别为76.9%和72.3%。(4)多因素Logistic回归分析显示,IL-33浓度≥74.4 ng/L(OR=13.364,95%CI:4.275~41.722,P<0.01)、NIHSS评分>14分(OR=4.420,95%CI:1.431~13.649,P=0.001)、侵入性操作(OR=12.158,95%CI:3.399~43.488,P<0.01)是急性缺血性Objective To investigate the relationship between serum interleukin 33(IL-33)and stroke-associated pneumonia and the predictive value of IL-33 for stroke-associated pneumonia in acute ischemic stroke.Methods From March 2019 to October 2019,140 patients with acute ischemic stroke(AIS)who were treated in the Department of Neurology,the First Affiliated Hospital of Chongqing Medical University were retrospectively recruited.According to occurrence of stroke-associated pneumonia within 48 hours after admission,140 patients were divided into pulmonary infection group(39 cases)and non-pulmonary infection group(101 cases).Baseline and clinical date of both groups were collected and analyzed.Baseline date included gender,age and risk factors of cerebrovascular disease;clinical data included National Institutes of Health Stroke Scale(NIHSS)score,IL-33 concentration,proportion of NIHSS score>14,and invasive operation(gastric tube,urinary tube,tracheotomy,etc.).Serum IL-33 concentration was detected by immunoenzyme-linked adsorption assay test.The predictive value of IL-33 for stroke-associated pneumonia in ischemic stroke was evaluated by receiver operating characteristic(ROC)curve and area under curve(AUC).With stroke-associated pneumonia as the dependent variable,variables included in univariate analysis(P<0.05)were further analyzed by multivariate Logistic regression analysis to explore influencing factors of stroke-associated pneumonia.Results(1)There were no statistically significant differences in hypertension,diabetes,hyperlipidemia,coronary heart disease(CHD),smoking,male proportion and age between the two groups(all P>0.05).(2)In pulmonary infection group,the rate of NIHSS score>14 and invasive operation was respectively higher than that of non-pulmonary infection group(53.8%[21/39]vs.18.8%[19/101],χ2=16.922;51.3%[20/39]vs.6.9%[7/101],χ2=35.554);IL-33 concentration and NIHSS score in pulmonary infection group was respectively higher than that of non-pulmonary infection group(92.1[72.4,144.5]ng/L vs.63.4[45.2,80.

关 键 词：白细胞介素类 白细胞介素33 预测 急性缺血性卒中 卒中相关性肺炎 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]