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

doi:10.3969/j.issn.1006-9771.2023.06.012

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (6): 708-713.doi: 10.3969/j.issn.1006-9771.2023.06.012

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

邓婷^1a, 陈敬绵^1a, 刘小蒙^1a, 姚晓华^1a, 刘芦姗^1a, 何威^1a, 张通^1b(), 芦海涛^1b()

1.中国康复研究中心北京博爱医院，a.急诊科;b.神经内科，北京市 100068

收稿日期:2022-08-26 修回日期:2023-05-29 出版日期:2023-06-25 发布日期:2023-07-14
通讯作者: 张通(1961-)，男，汉族，博士，主任医师，教授，博士研究生导师，主要研究方向：神经病学、神经康复学、神经系统退行性病等, E-mail： tommzhang@163.com；芦海涛(1975-)，女，汉族，博士，主任医师，教授，主要研究方向：意识障碍、认知功能障碍、运动功能障碍评估等, E-mail： 13051760807@163.com。
作者简介:邓婷(1970-)，女，汉族，湖南衡阳市人，博士，副主任医师，主要研究方向：急性脑血管病、急危重症患者救治及管理。

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

DENG Ting^1a, CHEN Jingmian^1a, LIU Xiaomeng^1a, YAO Xiaohua^1a, LIU Lushan^1a, HE Wei^1a, ZHANG Tong^1b(), LU Haitao^1b()

1. a. Department of Emergency; b. Department of Neurology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2022-08-26 Revised:2023-05-29 Published:2023-06-25 Online:2023-07-14
Contact: ZHANG Tong, E-mail: tommzhang@163.com; LU Haitao, E-mail: 13051760807@163.com

摘要/Abstract

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% CI 2.412~9.797, P < 0.001)、血小板计数> 300×10⁹/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> 300×10⁹/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。

关键词: 急性缺血性脑卒中, 卒中相关性肺炎, 危险因素

Abstract:

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) and α-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 and α-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.

Key words: acute ischemic stroke, stroke-associated pneumonia, risk factors

中图分类号:

R743.3

邓婷, 陈敬绵, 刘小蒙, 姚晓华, 刘芦姗, 何威, 张通, 芦海涛. 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[J]. 《中国康复理论与实践》, 2023, 29(6): 708-713.

DENG Ting, CHEN Jingmian, LIU Xiaomeng, YAO Xiaohua, LIU Lushan, HE Wei, ZHANG Tong, LU Haitao. Risk factors of stroke-associated pneumonia for patients with mild to moderate acute ischemic stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 708-713.

图/表 5

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项目	SAP组(n = 71)	非SAP组(n = 250)	t/χ²/Z值	P值
性别(男/女)/n	41/30	194/56	0.586	0.444
年龄/岁	79.51±9.92	66.38±10.93	1.109	< 0.001
发病时间/h	10.00 (3.00, 27.00)	13.50 (5.00, 33.00)	-1.131	0.258
收缩压/mmHg	155.00 (140.00, 172.00)	154.0 (139.75, 172.00)	-0.036	0.971
舒张压/mmHg	89.00 (78.00, 102.50)	90.00 (80.00, 103,00)	-1.124	0.259
NIHSS评分	4.00 (2.00, 7.00)	3.00 (2.00, 4.00)	-4.379	< 0.001
既往病史/n
高血压	64	207	2.266	0.132
糖尿病	40	125	0.889	0.346
高脂血症	62	224	0.295	0.587
心房纤颤	14	29	3.141	0.076
脑梗死	38	95	5.490	0.019
抗血小板治疗	15	60	0.255	0.614
白细胞/(10⁹·L^-1)	6.88 (5.49, 8.88)	6.55 (5.40, 8.09)	-1.608	0.108
血小板/(10⁹·L^-1)	223.00(183.00, 265.00)	203.50 (174.00, 232.00)	-1.536	0.125
D-二聚体/(mg·L^-1)	1.08 (0.36, 2.35)	0.33 (0.19, 0.75)	-6.403	< 0.001
hs-CRP/(mg·dL^-1)	0.57 (0.19, 2.18)	0.26 (0.10, 0.49)	-4.173	< 0.001
α-HBDH/(U·L^-1)	164.00 (138.00, 212.00)	140.50 (122,00, 167.00)	-4.426	< 0.001

项目	回归系数	标准误	Wald	P值	OR值	95%CI
年龄(> 70岁)	1.963	0.363	29.189	< 0.001	7.121	3.493~14.514
NIHSS(> 4分)	1.581	0.358	19.554	< 0.001	4.861	2.412~9.797
血小板(> 300×10⁹/L)	1.943	0.674	8.319	0.004	6.978	1.864~26.128
D-二聚体(> 1.0 mg/L)	1.110	0.354	9.858	0.002	3.036	1.518~6.071
常量	-3.306	0.342	93.617	< 0.001	0.037

回归模型系数的综合检验			拟合优度检验
χ²值	自由度	P值	HL	自由度	P值
8.189	1	0.004	1.509	3	0.680
99.974	4	< 0.001
99.974	4	< 0.001

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

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