肌少症指数与脑卒中相关性肺炎的关系及其与白蛋白的交互作用研究  

Study of the relationship between the sarcopenia index and stroke-associated pneumonia and its interaction with albumin

作　　者：秦梦真 董钰莹 王海燕[1] 王玲玲[3] QIN Mengzhen;DONG Yuying;WANG Haiyan;WANG Lingling(Emergency Center,Xinjiang Uygur Autonomous Region People’s Hospital,Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Medical College of Shihezi University,Xinjiang Uygur Autonomous Region,Shihezi 832000,China;Department of Neurology,Xinjiang Uygur Autonomous Region People’s Hospital,Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院急救中心,新疆乌鲁木齐830000 [2]石河子大学医学院,新疆石河子832000 [3]新疆维吾尔自治区人民医院神经内科,新疆乌鲁木齐830000

出　　处：《中国医药导报》2025年第7期123-128,共6页China Medical Herald

基　　金：新疆维吾尔自治区自然科学基金资助项目(2022D01C830)。

摘　　要：目的探讨肌少症指数(SI)与脑卒中相关性肺炎(SAP)的关系及其与白蛋白的交互作用。方法选取2021年1月至2023年10月于新疆维吾尔自治区人民医院神经内科住院的急性缺血性脑卒中患者710例,根据有无SAP分为非SAP组(610例)和SAP组(100例)。收集患者入院后24 h内的一般资料,通过logistic回归分析模型和限制性立方样条探讨SI和白蛋白对SAP的影响,并进一步分析其交互作用。结果两组年龄、既往脑卒中/TIA史、吞咽困难、入院美国国立卫生院卒中量表评分、白蛋白、淋巴细胞、中性粒细胞、胱抑素C、血尿素氮、同型半胱氨酸和SI指数比较上,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示年龄、吞咽困难、白蛋白、中性粒细胞和SI指数是AIS患者并发SAP的影响因素(P<0.05)。Spearman相关分析结果显示,SI指数与AIS患者年龄(r=-0.291,<0.001)和SAP(r=-0.140,P<0.001)呈负相关,与白蛋白(r=0.217,P<0.001)呈正相关。限制性立方样条分析结果显示,SI指数与AIS患者SAP的发生风险之间存在非线性剂量-反应关系(P_(value)=0.006,PNonlinear<0.001),且曲线呈“L”型;白蛋白与AIS患者SAP的发生风险之间存在负向线性剂量-反应关系(P_(value)=0.159,PNonlinear<0.001)。交互作用分析结果显示,调整混杂因素后,SI指数和白蛋白对AIS患者并发SAP存在相乘交互作用(OR=2.745,95%CI:1.073~7.022,P<0.05);相加交互作用不存在,超额相对危险度为1.707,95%CI:0.367~3.601;归因百分比为0.636,95%CI:0.158~0.960;交互作用指数未测出。结论SI和白蛋白是评估SAP风险的重要指标,并且这两项指标与SAP风险之间存在相乘交互作用。临床医护人员应密切关注脑卒中患者的肌肉情况和营养状况,以便更好地评估SAP的发生风险。Objective To explore the relationship between sarcopenia index(SI)and stroke-associated pneumonia(SAP),as well as the interaction between SI and albumin.Methods A total of 710 patients with acute ischemic stroke admitted to the Department of Neurology at the Xinjiang Uygur Autonomous Region People’s Hospital from January 2021 to October 2023 were selected,they were divided into non-SAP group(610 cases)and SAP group(100 cases)according to the presence or absence of SAP.Baseline information was collected within 24 hours after admission.The impact of SI and albumin on SAP was analyzed using logistic regression models and restricted cubic splines,and their interaction was further examined.Results There were significant differences in age,previous stroke/TIA history,dysphagia,admission National Institutes of Health stroke seale score,albumin,lymphocytes,neutrophils,cystatin C,urea nitrogen,homocysteine,and SI index between the two groups(P<0.05).Multivariate logistic regression analysis showed that age,dysphagia,albumin,neutrophils,and SI index were the influencing factors of SAP in AIS patients(P<0.05).Spearman correlation analysis showed that SI index was negatively correlated with age(r=-0.291,P<0.001)and SAP(r=-0.140,P<0.001),and positively correlated with albumin(r=0.217,P<0.001).The results of restricted cubic spline analysis showed that there was a nonlinear dose-response relationship between SI index and the risk of SAP in AIS patients(P_(value)=0.006,P_(Nonlinear)<0.001),and the curve was“L”type;there was a negative linear dose-response relationship between albumin and the risk of SAP in AIS patients(P_(value)=0.159,P_(Nonlinear)<0.001).The results of interaction analysis showed that after adjusting for confounding factors,SI index and albumin had multiplicative interaction on SAP in AIS patients(OR=2.745,95%CI:1.073-7.022,P<0.05).There was no additive interaction,and the excess relative risk was 1.707,95%CI:0.367-3.601.The attribution percentage was 0.636,95%CI:0.158-0.960;the interaction index was not

关 键 词：肌少症指数 脑卒中相关性肺炎 限制性立方样条 交互作用 

分 类 号：R743.3[医药卫生—神经病学与精神病学]