老年脑卒中伴肺部感染危险因素及BNP、TNF-α、Lp(a)联合诊断价值  

Risk factors for pulmonary infection and value of combined diagnosis of BNP, TNF-α, Lp(a) in elderly stroke

作　　者：吴晓力 倪珏民 陈建娥 王建 聂栋良 WU Xiao-li;NI Jue-min;CHEN Jian-e;WANG Jian;NIE Dong-liang(The First People's Hospital of Fuyang District,Hatigzhou,Zhejiang 311400,China;不详)

机构地区：[1]杭州市富阳区第一人民医院神经内科,浙江杭州311400 [2]杭州市五云山疗养院内科,浙江杭州310008

出　　处：《中华医院感染学杂志》2020年第23期3612-3616,共5页Chinese Journal of Nosocomiology

基　　金：杭州市科技局科研基金资助项目(20170534B16)。

摘　　要：目的探究脑钠肽(BNP)、肿瘤坏死因子-α(TNF-α)、脂蛋白(a)[Lp(a)]联合诊断老年脑卒中伴肺部感染的价值及危险因素。方法选取2016年5月-2019年8月富阳区第一人民医院45例老年脑卒中伴肺部感染患者作为感染组,同期纳入51例老年脑卒中未发生肺部感染患者作为未感染组。统计比较两组临床特征,探究老年脑卒中伴肺部感染发生的影响因素,分析BNP、TNF-α、Lp(a)水平与老年脑卒中伴肺部感染患者神经功能(NIHSS评分)相关性,及其诊断老年脑卒中伴肺部感染的价值。结果老年脑卒中伴肺部感染的发生受格拉斯哥昏迷量表(GCS)评分、NIHSS评分、长期吸烟史、合并基础疾病、伴有吞咽障碍、侵袭性操作次数≥3次、抗菌药物使用种类≥2种、卧床时间>7 d、卒中类型及血清BNP、TNF-α、Lp(a)水平影响(P<0.05);老年脑卒中伴肺部感染患者血清TNF-α、BNP、Lp(a)水平与NIHSS评分存在正相关关系(P<0.05);3种血清指标中,血清TNF-α诊断老年脑卒中伴肺部感染的曲线下面积(AUC)最大,最佳诊断敏感度为77.78%,特异度为80.39%。结论老年脑卒中伴肺部感染的发生受颅脑损伤程度、神经功能缺损程度、血清BNP、TNF-α、Lp(a)水平升高等诸多因素影响,其中血清BNP、TNF-α、Lp(a)水平可反映出感染患者神经功能缺损情况,且在脑卒中伴肺部感染的早期诊断方面具有较高应用价值。OBJECTIVE To investigate the risk factors of pulmonary infection, and evaluate the value of combined diagnosis of brain natriuretic peptide(BNP), tumor necrosis factor-α(TNF-α) and lipoprotein(a)(Lp(a)) in the diagnosis of the disease. METHODS From May 2016 to Aug. 2019, 45 elderly stroke patients with lung infection in Fuyang District First People’s Hospital were recruited as the infection group, and 51 elderly stroke patients without lung infection were included as the uninfected group. The clinical characteristics of the two groups were statistically compared, and the factors affecting the occurrence of stroke and lung infection in the elderly were explored. The correlation between BNP, TNF-α, Lp(a) levels and neurological function(NIHSS score) in elderly stroke patients with pulmonary infection and their value in diagnosing elderly stroke with pulmonary infection were analyzed. RESULTS The occurrence of elderly stroke with lung infection was affected by the Glasgow Coma Scale(GCS) score, NIHSS score, long-term smoking history, combined with underlying diseases, accompanied by swallowing disorders, the number of invasive operations ≥3 times, the use of antibacterial drugs ≥2, and the time spent in bed for more than 7 days, stroke type and serum BNP, TNF-α, Lp(a) levels(P<0.05). There was a positive correlation between serum TNF-α, BNP, Lp(a) levels and NIHSS score in elderly patients with stroke and lung infection(P<0.05). Among the three serum indexes, the area under the curve(AUC) of serum TNF-α in the diagnosis of elderly stroke with pulmonary infection was the highest at 0.818, with diagnostic sensitivity of 77.78% and specificity of 80.39%. CONCLUSION The occurrence of senile stroke with pulmonary infection is affected by many factors such as the degree of brain injury, the degree of neurological deficits, the increase of serum BNP, TNF-α, and Lp(a) levels. Among them, serum BNP, TNF-α, Lp(a) levels can reflect the neurological deficits in the infected patients, and may have high application

关 键 词：脑卒中 肺部感染 脑钠肽 肿瘤坏死因子-Α 脂蛋白(a) 神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]