轻中度急性缺血性脑卒中并发卒中相关性肺炎的危险因素分析  

Risk factors of stroke-associated pneumonia for patients with mild to moderate acute ischemic stroke

作　　者：邓婷 陈敬绵[1] 刘小蒙 姚晓华[1] 刘芦姗[1] 何威[1] 张通[2] 芦海涛[2] DENG Ting;CHEN Jingmian;LIU Xiaomeng;YAO Xiaohua;LIU Lushan;HE Wei;ZHANG Tong;LU Haitao(Department of Emergency,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Neurology,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院急诊科,北京市100068 [2]中国康复研究中心北京博爱医院神经内科,北京市100068

出　　处：《中国康复理论与实践》2023年第6期708-713,共6页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的 探讨轻中度急性缺血性脑卒中(AIS)患者并发卒中相关性肺炎(SAP)的危险因素。方法 2016年10月至2019年12月,北京博爱医院轻中度AIS患者321例根据是否并发SAP分为SAP组(n=71)和非SAP组(n=250)。记录患者性别、年龄、发病时间、收缩压、舒张压、入院时美国国立卫生研究院卒中量表(NIHSS)评分、既往病史,以及白细胞和血小板计数、D-二聚体、超敏C-反应蛋白(hs-CRP)和α-羟丁酸脱氢酶(α-HBDH)等实验室指标。结果 单因素分析显示,影响SAP的变量包括年龄、NIHSS评分、高血压史、心房纤颤、脑梗死病史、白细胞计数、血小板计数,以及hs-CRP、D-二聚体和α-HBDH水平(P <0.2)。多因素Logistic回归模型显示,年龄> 70岁(OR=7.121,95%CI 3.493~14.514,P <0.001)、NIHSS评分> 4分(5~10分,OR=4.861,95%CI2.412~9.797,P <0.001)、血小板计数> 300×10~9/L (OR=6.978,95%CI 1.864~26.128,P=0.004)和D-二聚体水平> 1.0 mg/L (OR=3.036,95%CI 1.518~6.071,P=0.002)是SAP的危险因素。模型很好地拟合了原始数据(HL=1.509,P=0.680),具有良好的预测能力(AUC=0.847,95%CI 0.796~0.898,P <0.001)。结论 年龄> 70岁、NIHSS评分> 4分(5~10分)、血小板计数> 300×10~9/L和D-二聚体水平> 1.0 mg/L是轻中度AIS患者SAP的危险因素。Objective To explore the risk factors of stroke-associated pneumonia(SAP)for patients with mild to moderate acute ischemic stroke(AIS).Methods From October,2016 to December,2019,321 patients with mild to moderate AIS in Beijing Bo'ai Hospital were collected and divided into SAP group(n=71)and non-SAP group(n=250)according to whether they were complicated with SAP.Gender,age,time from symptom onset to admission,systolic pressure,diastolic pressure,scores of National Institutes of Health Stroke Scale(NIHSS)at admission,and medical history were recorded.Laboratory indexes including the count of white blood cell and platelet,levels of D-dimer,hypersensitive C-reactive protein(hs-CRP)andα-hydroxybutyrate dehydrogenase(α-HBDH)were measured.Results Univariate analysis showed that age,NIHSS score,history of hypertension,atrial fibrillation,prior cerebral infarction,the count of white blood cell and platelet,the levels of D-dimer,hs-CRP andα-HBDH were the influencing factors of SAP(P<0.2).Multivariate Logistic regression showed that age>70 years old(OR=7.121,95%CI 3.493 to 14.514,P<0.001),NIHSS score>4(5 to 10,OR=4.861,95%CI 2.412 to 9.797,P<0.001),the count of platelet>300×109/L(OR=6.978,95%CI 1.864 to 26.128,P=0.004),and the level of D-dimer>1.0 mg/L(OR=3.036,95%CI,1.518 to 6.071,P=0.002)were the risk factors of SAP.The model fitted the original data well(HL=1.509,P=0.680)and appeared a good prediction(AUC=0.847,95%CI 0.796 to 0.898,P<0.001).Conclusion Age>70 years old,NIHSS score>4(5 to 10),the count of platelet>300×109/L and the level of D-dimer>1.0 mg/L were the risk factors of SAP for patients with mild to moderate AIS.

关 键 词：急性缺血性脑卒中 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]