血清CCL21和CXCR3预测急性缺血性卒中患者的卒中相关性肺炎  

Serum CCL21 and CXCR3 predict stroke-associated pneumonia in patients with acute ischemic stroke

作　　者：翟海燕 李林 祝丽芳 任春娟 魏丹 杨杰 Zhai Haiyan;Li Lin;Zhu Lifang;Ren Chunjuan;Wei Dan;Yang Jie(Department of Neurology,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China;Department of Respiratory Medicine,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China)

机构地区：[1]陕西省核工业二一五医院神经内科,咸阳712000 [2]陕西省核工业二一五医院呼吸内科,咸阳712000

出　　处：《国际脑血管病杂志》2024年第7期495-499,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性缺血性卒中(acute ischemic stroke,AIS)患者血清C-C基序趋化因子配体21(C-C motif chemokine ligand 21,CCL21)和C-X-C基序趋化因子受体3(C-X-C motif chemokine receptor 3,CXCR3)水平对卒中相关性肺炎(stroke-associated pneumonia,SAP)的预测价值。方法前瞻性纳入2020年7月至2023年12月在陕西省核工业二一五医院住院治疗的AIS患者。使用医院电子病例系统收集入院时血清CCL21和CXCR3检测结果以及一般临床资料。通过多变量logistic回归分析确定SAP的独立影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清CCL21和CXCR3水平对SAP的预测价值。结果共纳入150例AIS患者,男性91例(60.67%),年龄(61.48±7.92)岁。其中,41例(27.33%)在住院期间发生SAP。SAP组血清CCL21和CXCR3水平、美国国立卫生研究院卒中量表评分、格拉斯哥昏迷量表评分、有创机械通气、住院时间以及合并高血压和糖尿病的患者比例与非SAP组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,血清CCL21[优势比(odds ratio,OR)1.022,95%置信区间(confidence interval,CI)1.006~1.039;P=0.006]和CXCR3(OR 1.036,95%CI 1.018~1.054;P<0.001)水平均是SAP的独立危险因素。ROC曲线分析显示,血清CCL21和CXCR3水平单独预测SAP的效能良好,曲线下面积分别为0.730(95%CI 0.634~0.825)和0.807(95%CI 0.721~0.892),两者联合预测的曲线下面积为0.881(95%CI 0.819~0.943)。结论AIS患者血清CCL21和CXCR3水平普遍较高。血清CCL21和CXCR3水平均与SAP密切相关,两者单独或联合对SAP均具有良好的预测效果。ObjectiveTo investigate the predictive value of serum levels of C-C motif chemokine ligand 21(CCL21)and C-X-C motif chemokine receptor 3(CXCR3)for stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS).MethodsPatients with AIS admitted to No.215 Hospital of Shaanxi Nuclear Industry from July 2020 to December 2023 were prospectively included.Serum CCL21 and CXCR3 test results and general clinical data at admission were collected using the hospital electronic medical record system.The independent influencing factors of SAP were identified through multivariate logistic regression analysis,and the predictive value of serum CCL21 and CXCR3 levels for SAP were analyzed by receiver operating characteristic(ROC)curves.ResultsA total of 150 patients with AIS were enrolled,including 91 males(60.67%),aged 61.48±7.92 years.Among them,41 patients(27.33%)developed SAP during hospitalization.There were significant differences in serum CCL21 and CXCR3 levels,National Institutes of Health Stroke Scale score,Glasgow Coma Scale score,invasive mechanical ventilation,length of hospital stay,and the proportion of patients with hypertension and diabetes between the SAP group and the non-SAP group(all P<0.05).Multivariate logistic regression analysis showed that serum CCL21(odds ratio[OR]1.022,95%confidence interval[CI]1.006-1.039;P=0.006)and CXCR3(OR 1.036,95%CI 1.018-1.054;P<0.001)levels were the independent risk factors for SAP.ROC curve analysis showed that serum CCL21 and CXCR3 levels had good predictive power separately for SAP.The areas under the curve was 0.730(95%CI 0.634-0.825)and 0.807(95%CI 0.721-0.892),respectively.The combined prediction of the two showed an area under the curve of 0.881(95%CI 0.819-0.943).ConclusionThe patients with AIS generally have higher levels of serum CCL21 and CXCR3.The levels of serum CCL21 and CXCR3 are closely associated with SAP,and both of them have a good predictive effect on SAP alone or in combination.

关 键 词：缺血性卒中 肺炎 趋化细胞因子CCL21 受体 CXCR3 危险因素 生物标志物 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]