急性脑梗死恢复期并发肺部感染的影响因素及其甲状腺激素诊断价值  

Influencing factors for pulmonary infection in patients with convalescence of acute cerebral infarction and diagnostic value of thyroid hormone

作　　者：王鑫[1] 邵洲力 叶祥明[1] 洪乐凤[1] 潘克勤[1] 张幸如 WANG Xin;SHAO Zhou-li;YE Xiang-ming;HONG Le-feng;PAN Ke qin;ZHANG Xing-ru(Zhejiang Provincial People's Hospital(Affiliated People's Hospital of Hangzhou Medical College),Zhejiang Institute of Rehabilitation and Sports Medicine,Hangzhou,Zhejiang 310024,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)康复医学科,浙江省康复与运动医学研究所,浙江杭州310024

出　　处：《中华医院感染学杂志》2022年第4期516-520,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2019KY301);浙江省自然基金资助项目(LQ20H170003)。

摘　　要：目的 探究急性脑梗死(ACI)恢复期并发肺部感染患者血清甲状腺激素相关指标、降钙素原(PCT)、C-反应蛋白(CRP)/白蛋白(ALB)的评估价值及其影响因素。方法 选择浙江省人民医院2018年7月-2020年3月收诊的258例急性脑梗死恢复期患者,其中并发肺部感染设为感染组36例,无肺部感染设为未感染组222例。另选同期体检健康人60名为对照组。监测促甲状腺激素(TSH)、游离甲状腺素(FT4)、三碘甲状腺原氨酸(FT3)、PCT、CRP、ALB,归纳ACI恢复期并发肺部感染的影响因素以及甲状腺激素、PCT、CRP/ALB对肺部感染的预测价值。结果 与对照组比,未感染组与感染组血清FT3、FT4、ALB水平降低,血清TSH、PCT、CRP、CRP/ALB升高(P<0.05);与未感染组比,感染组上述指标降低或升高的幅度更大(P<0.05);侵入性操作、PCT和CRP/ALB水平升高是ACI恢复期并发肺部感染的独立危险因素(P<0.05)。甲状腺激素水平、PCT、CRP/ALB均有较高的对急性脑梗死恢复期患者合并肺部感染的诊断评估价值,其联合应用更高,AUC(0.95CI)为0.880(0.816~0.943)。结论 血清甲状腺激素水平、PCT、CRP/ALB对急性脑梗死恢复期患者合并肺部感染的诊断评估价值较高。OBJECTIVE To explore the evaluation value and influencing factors of serum thyroid hormone related indicators(FT3, FT4, etc.), procalcitonin(PCT), and C-reactive protein(CRP)/albumin(ALB) in patients with acute cerebral infarction(ACI) complicated with pulmonary infection in convalescent stage. METHODS A total of 258 patients with acute cerebral infarction in convalescent stage treated in Zhejiang Provincial people′s hospital from Jul 2018 to Mar 2020, were selected, of which, 36 patients complicated with pulmonary infection were set as the infected group, and 222 patients without pulmonary infection were set as the uninfected group. Another 60 healthy people underwent physical examination during the same period were selected as the control group. The changes of thyroid stimulating hormone(TSH), free thyroxine(FT4), triiodothyronine(FT3), PCT, CRP and ALB were monitored. The influencing factors of pulmonary infection during ACI recovery period, as well as the predictive value of thyroid hormone, PCT and CRP/ALB on pulmonary infection were summarized. RESULTS Compared with the control group, the levels of serum FT3, FT4 and ALB in the uninfected group and the infected group were decreased, while the levels of serum TSH,PCT, CRP and CR/ALB were increased, the difference was significant(P<0.05);Compared with the uninfected group, the above indexes in the infected group were decreased or increased significantly(P<0.05). The invasive operation, increased level of PCT and CRP/ALB were independent risk factors for pulmonary infection during ACI recovery(P<0.05). Thyroid hormone level, PCT and CRP/ALB had higher diagnostic value for patients with acute cerebral infarction complicated with pulmonary infection in convalescent stage, and their combined application was higher, AUC(0.95% CI) was 0.880(0.816~0.943). CONCLUSION Serum thyroid hormone level, PCT and CRP/ALB were of high value in the diagnosis and evaluation of patients with acute cerebral infarction complicated with pulmonary infection in convalescent stage.

关 键 词：急性脑梗死 恢复期 肺部感染 影响因素 预后 血清甲状腺激素相关指标 降钙素原 C-反应蛋白/白蛋白 

分 类 号：R563.1[医药卫生—呼吸系统]