大血管闭塞急性缺血性脑卒中发生卒中相关性肺炎预测模型构建  

The prediction model of stroke-associated pneumonia in patients with acute ischemic stroke caused by large vessel occlusion

作　　者：毛凤君 梁玉 赛俊杰 MAO Fengjun;LIANG Yu;SAI Junjie(Department of Respiratory Medicine,Lanshan District People′s Hospital of Linyi City,Shandong 276000,China;Department of Neurology,Linyi People’s Hospital,Linyi,Shandong 276000,China)

机构地区：[1]临沂市兰山区人民医院呼吸科,山东临沂276000 [2]山东第二医科大学附属临沂市人民医院神经内科,山东临沂276000

出　　处：《临床肺科杂志》2025年第5期722-725,731,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨大血管闭塞急性缺血性脑卒中(AIS-LVO)发生卒中相关性肺炎(SAP)的危险因素,并构建列线图模型。方法回顾性连续纳入2024年1月至2024年9月临沂市人民医院收治的173例AIS-LVO患者,根据是否发生SAP将患者分为SAP组(n=61)和非SAP组(n=112)。收集患者的病例资料以及实验室指标,进行组间比较及Logistic回归分析,找出AIS-LVO发生SAP的独立危险因素,并构建列线图模型,采用ROC曲线、校准曲线、Hosemer-Lemeshow对模型进行评价。结果AIS-LVO发生SAP的比例为35.3%。两组年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、梗死部位、吞咽困难、白细胞数、中性粒细胞数有统计学差异;其中年龄增长(OR=1.050,95%CI:1.012~1.090,P=0.010)、NIHSS评分增加(OR=1.124,95%CI:1.029~1.228,P=0.010)、吞咽困难(OR=2.393,95%CI:1.122~5.102,P=0.024)、白细胞数增加(OR=1.158,95%CI:1.005~1.333,P=0.042)是AIS-LVO患者发生SAP的独立危险因素。预测模型ROC曲线下面积为0.801(95%CI:0.732~0.870,P<0.001),灵敏度为75.4%,特异度为74.1%。H-L检验结果χ^(2)=4.511,P>0.05。校准曲线显示预测模型拟合优度良好。结论年龄增长、NIHSS评分增加、吞咽困难、白细胞数增加是AIS-LVO发生SAP的独立影响因素。列线图模型拟合优度良好,有助于预防AIS-LVO患者发生SAP。Objective To investigate the risk factors associated with stroke-associated pneumonia(SAP)in patients diagnosed with acute ischemic stroke-large vessel occlusion(AIS-LVO),as well as to develop a nomogram model.Methods The present study retrospectively included 173 patients with AIS-LVO admitted to Linyi People′s Hospital between January and September 2024.The patients were divided into the SAP group(n=61)and the non-SAP group(n=112)according to whether SAP occurred.The clinical data and laboratory indicators of the patients were collected for comparison between groups and Logistic regression analysis to identify the independent risk factors associated with SAP in AIS-LVO.Subsequently,a nomogram model was developed.The performance of the model was assessed using the ROC curve,calibration curve,and Hosmer-Lemeshow test.Results The incidence of SAP in AIS-LVO was 35.3%.There were statistically significant differences between the two groups in terms of age,admission to National Institutes of Health Stroke Scale(NIHSS)scores,infarction location,treatment methods,dysphagia,white blood cell count,and neutrophil count.Among them,age(OR=1.050,95%CI:1.012-1.090,P=0.010)and National Institutes of Health Stroke Scale(NIHSS)score(OR=1.124,95%CI:1.029-1.228,P=0.010),dysphagia(OR=2.393,95%CI:1.122-5.102,P=0.024),white blood cell(OR=1.158,95%CI:1.005-1.333,P=0.042)were the independent risk factors for SAP in patients with AIS-LVO.The area under the ROC curve of the nomogram model was 0.801(95%CI:0.732-0.870,P<0.001),with a sensitivity of 75.4%and a specificity of 74.1%.H-L test resultsχ^(2)=4.511,P>0.05.The nomogram model had a good goodness of fit.Conclusion Age,NIHSS score,dysphagia,and white blood cell are independent influencing factors for SAP in AIS-LVO.The nomogram model has a good goodness of fit,which is helpful in preventing SAP in AIS-LVO patients.

关 键 词：缺血性脑卒中 大血管闭塞 卒中相关性肺炎 危险因素 列线图 

分 类 号：R743.3[医药卫生—神经病学与精神病学]