血清sICAM-1与HLA-DR对脑卒中患者隐性吸入性肺炎的预测价值  

Prognostic value of serum sICAM-1 and HLA-DR for recessive aspiration pneumonia in stroke patients

作　　者：刘磊 侯婷婷[2] 张文筱[3] 张文学 尹艳霞 LIU Lei;HOU Tingting;ZHANG Wenxiao;ZHANG Wenxue;YIN Yanxia(Kaifeng Central Hospital,Kaifeng 475000,China;Huaihe Hospital,Henan University,Kaifeng 475000,China;Henan Provincial People’s Hospital,Zhengzhou 453003,China)

机构地区：[1]开封市中心医院,河南开封475000 [2]河南大学淮河医院,河南开封475000 [3]河南省人民医院,河南郑州453003

出　　处：《中国实用神经疾病杂志》2025年第3期331-335,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20230795)。

摘　　要：目的评估血清可溶性细胞间黏附分子-1(sICAM-1)和人类白细胞抗原-DR(HLA-DR)预测脑卒中患者隐性吸入性肺炎(SAP)中的诊断价值。方法回顾性分析2023-02—2024-02河南省人民医院收治的80例脑卒中患者,根据SAP的发生状况分为SAP组(n=28)和非SAP组(n=52)。比较2组患者的临床特征及生化指标,包括性别、年龄、BMI、血压、饮酒史、吸烟史、白细胞计数、中性粒细胞计数及血清sICAM-1、HLA-DR水平。通过Lasso回归筛选重要指标,应用有序Logistic回归分析其与SAP的关系,通过受试者工作特征(ROC)曲线评估sICAM-1和HLA-DR的预测能力。结果SAP组与非SAP组在性别、年龄、BMI、收缩压、舒张压及饮酒史方面无统计学差异(P>0.05),SAP组吸烟史、白细胞及中性粒细胞计数显著升高(P<0.05)。SAP组患者血清sICAM-1水平显著高于非SAP组,HLA-DR显著低于非SAP组(P<0.05)。多因素Logistic回归分析显示,sICAM-1升高和HLA-DR降低是发生SAP的独立危险因素(P<0.05)。ROC曲线分析显示,sICAM-1、HLA-DR单独诊断SAP的曲线下面积(AUC)分别为0.629、0.727,灵敏度分别为85.19%、96.30%,特异度分别为82.59%、80.74%。二者联合诊断的AUC提高至0.847,灵敏度、特异度分别为72.22%、83.33%。结论血清sICAM-1和HLA-DR是预测脑卒中患者SAP的重要标志物,联合使用具有更高的诊断价值。Objective To evaluate the diagnostic value of serum soluble intercellular adhesion molecule-1(sICAM-1)and human leukocyte antigen-DR(HLA-DR)in predicting silent aspiration pneumonia(SAP)in stroke patients.Methods A retrospective analysis was conducted on 80 stroke patients admitted to Henan Provincial People’s Hospital from February 2023 to February 2024.The patients were divided into SAP group(n=28)and non-SAP group(n=52)based on the occurrence of SAP.Clinical characteristics and biochemical indicators of the two groups were compared,including sex,age,body mass index(BMI),blood pressure,alcohol history,smoking history,white blood cell count,neutrophil count,and serum levels of sICAM-1 and HLA-DR.Important indicators were selected through Lasso regression and their relationships with SAP were analyzed by ordinal Logistic regression.In addition,receiver operating characteristic(ROC)curves were used to assess the predictive values of sICAM-1 and HLA-DR.Results There were no significant differences between the SAP group and the non-SAP group in terms of sex,age,BMI,systolic and diastolic blood pressure,and alcohol history(P>0.05).However,the SAP group showed significantly higher smoking history,white blood cell count,and neutrophil count(P<0.05).Serum sICAM-1 levels were significantly higher and HLA-DR levels were significantly lower in the SAP group compared to the non-SAP group(P<0.05).Multivariate Logistic regression analysis indicated that increased sICAM-1 and decreased HLA-DR were independent risk factors for SAP(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for sICAM-1 and HLA-DR in diagnosing SAP was 0.629 and 0.727,respectively,with sensitivity of 85.19%and 96.30%,and specificity of 82.59%and 80.74%,respectively.Combined diagnosis improved the AUC to 0.847,with sensitivity and specificity of 72.22%and 83.33%,respectively.Conclusion Serum sICAM-1 and HLA-DR are important biomarkers for predicting SAP in stroke patients,and the combined application has higher diagnostic value.

关 键 词：隐性吸入性肺炎 脑卒中 可溶性细胞间黏附分子-1 人类白细胞抗原DR 血清 诊断价值 中性粒细胞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]