入院时YKL-40预测急性缺血性卒中患者的卒中相关性肺炎和转归  

YKL-40 at admission predicts stroke-associated pneumonia and outcome in patients with acute ischemic stroke

作　　者：石国美 汪小荣[1] 徐武[1] 郭民旺[1] 王蒙[2] 龚鹏宇 周俊山[2] 周汝娟[1] Shi Guomei;Wang Xiaorong;Xu Wu;Guo Minwang;Wang Meng;Gong Pengyu;Zhou Junshan;Zhou Rujuan(Department of Neurology,Taixing People’s Hospital,Taizhou 225400,China;Department of Neurology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Chin)

机构地区：[1]泰兴市人民医院神经内科,泰州225400 [2]南京医科大学附属南京医院(南京市第一医院)神经内科,南京210006

出　　处：《国际脑血管病杂志》2022年第8期569-576,共8页International Journal of Cerebrovascular Diseases

基　　金：江苏省科协青年科技人才托举工程(TJ2021019);南京医科大学康达学院2020年度科研课题(KD2020KYJJZD019)。

摘　　要：目的探讨入院时YKL-40对急性缺血性卒中(acute ischemic stroke, AIS)患者发生卒中相关性肺炎(stroke-associated pneumonia, SAP)和90 d时转归不良的预测价值。方法前瞻性纳入2020年2月至2021年3月在泰兴市人民医院住院治疗的AIS患者。转归不良定义为发病后90 d时改良Rankin量表评分3~6分。采用多变量logistic回归分析确定SAP及转归不良的独立预测因素, 并通过受试者工作特征(receiver operating characteristic, ROC)曲线评估血清YKL-40对SAP及90 d时转归不良的预测价值。结果共纳入377例AIS患者, 血清YKL-40中位数为127.16 μg/L, 104例(27.6%)发生SAP, 126例(33.4%)在发病后90 d时转归不良。多变量logistic回归分析显示, 校正混杂因素后, YKL-40是SAP[优势比(odds ratio,OR)1.005, 95%置信区间(confidence interval,CI)1.003~1.008;P=0.001]和90 d时转归不良(OR 1.009, 95%CI 1.006~1.011;P=0.001)的独立预测因素。ROC曲线分析表明, YKL-40预测SAP的曲线下面积为0.769(95%CI 0.713~0.824;P<0.001), 最佳截断值为168.70 μg/L, 敏感性和特异性分别为71.2%和75.1%;YKL-40预测90 d时转归不良的曲线下面积为0.787(95%CI 0.735~0.840;P<0.001), 最佳截断值为195.56 μg/L, 敏感性和特异性分别为68.3%和84.1%。结论入院时血清YKL-40较高对AIS患者SAP及90 d时转归不良具有良好的预测价值。Objective To investigate the predictive value of YKL-40 at admission on stroke-associated pneumonia(SAP)and poor outcome in patients with acute ischemic stroke(AIS).Methods Patients with AIS admitted to Taixing People’s Hospital from February 2020 to March 2021 were enrolled prospectively.The poor outcome was defined as 3-6 points on the modified Rankin Scale at 90 d after onset.Multivariate logistic regression analysis was used to determine the independent predictors of SAP and poor outcome,and the predictive value of serum YKL-40 on SAP and poor outcome was evaluated by receiver operating characteristic(ROC)curve.Results A total of 377 patients with AIS were enrolled.The median serum YKL-40 was 127.16μg/L.One hundred and four patients(27.6%)had SAP,and 126(33.4%)had poor outcomes at 90 d after onset.Multivariate logistic regression analysis showed that after adjusting for confounding factors,YKL-40 was the independent predictors of SAP(odds ratio[OR]1.005,95%confidence interval[CI]1.003-1.008;P=0.001)and poor outcome at 90 d(OR 1.009,95%CI 1.006-1.011;P=0.001).The ROC curve analysis showed that the area under the curve of YKL-40 for predicting SAP was 0.769(95%CI 0.713-0.824;P<0.001),the best cutoff value was 168.70μg/L,and the sensitivity and specificity were 71.2%and 75.1%respectively;the area under the curve of YKL-40 for predicting poor outcome at 90 d was 0.787(95%CI 0.735-0.840;P<0.001),the best cutoff value was 195.56μg/L,and the sensitivity and specificity were 68.3%and 84.1%respectively.Conclusion Higher serum YKL-40 at admission has a good predictive value for SAP and poor outcome at 90 d in patients with AIS.

关 键 词：卒中 脑缺血 肺炎 壳多糖酶3样蛋白1 治疗结果 生物标志物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]