血清超敏C反应蛋白预测静脉溶栓治疗患者的卒中相关性肺炎

目的探讨血清超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)对接受静脉溶栓治疗的急性缺血性卒中(acute ischemic stroke,AIS)患者的卒中相关性肺炎(stroke associated pneumonia,SAP)的预测价值。方法回顾性收集2015年5月至2017年4月期间在南京市第一医院接受静脉溶栓治疗的AIS患者的临床资料。采用多变量logistic回归分析确定AIS患者静脉溶栓后SAP的独立危险因素。利用受试者工作特征(receiver operating characteristic,ROC)曲线以及列线图方法分析hs-CRP对SAP的预测价值。结果共纳入243例接受静脉溶栓治疗的AIS患者,其中63例(34.6%)发生SAP。SAP组与非SAP组年龄(P=0.006)、白细胞计数(P=0.044)、空腹血糖水平(P=0.003)、血清hs-CRP水平(P=0.001)、hs-CRP分类(P=0.001)及吞咽困难发生率(P=0.035)差异有统计学意义。多变量logistic回归分析显示,校正混杂因素后,以血清hs-CRP水平第1四分位数组作为参考,hs-CRP第3四分位数组(优势比18.790,95%可信区间4.771~74.007;P=0.001)和第4四分位数组(优势比54.054,95%可信区间12.248~324.088;P=0.001)是SAP的独立预测因素。基线血清hs-CRP水平预测SAP的ROC曲线下面积为0.805(95%可信区间0.742~0.868;P<0.001)。hs-CRP最佳截断值为5.54 mg/L时,预测SAP的敏感性和特异性分别为76.11%和76.19%。列线图分析也显示,hs-CRP是SAP的独立预测因素(一致性指数0.862,95%可信区间0.738~0.986;P<0.001)。结论血清hs-CRP增高是接受静脉溶栓治疗的AIS患者SAP的独立预测因素,预测价值较高。

Serum hypersensitive C-reactive protein predicts stroke-associated pneumonia in patients treated with intravenous thrombolysis

Objective To investigate the predictive value of serum hypersensitive C-reactive protein(hs-CRP)for stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS)who received intravenous thrombolysis.Methods From May 2015 to April 2017,the clinical data of the patients with AIS treated with intravenous thrombolysis in Nanjing First Hospital were collected retrospectively.Multivariate logistic regression analysis was used to determine the independent risk factors for SAP in patients with AIS after intravenous thrombolysis.Receiver operating characteristic(ROC)curve and nomogram-based methods were used to analyze the predictive value of hs-CRP for SAP.Results A total of 243 patients with AIS who received intravenous thrombolysis were included,and 63(34.6%)of them had SAP.There were significant differences in age(P=0.006),leukocyte count(P=0.044),fasting blood glucose level(P=0.003),serum hs-CRP level(P=0.001),hs-CRP classification(P=0.001)and dysphagia rate(P=0.035)between the SAP group and non-SAP group.Multivariate logistic regression analysis showed that after adjusting for the confounding factors,taking the first quartile of serum hs-CRP level as a reference,the third quantile(odds ratioOR]18.790,95%confidence intervalCI]4.771-74.007;P=0.001)and the fourth quantile(OR 54.054,95%CI 12.248-324.088;P=0.001)of hs-CRP were the independent predictors of SAP.The area under the ROC curve of the baseline serum hs-CRP level for predicting SAP was 0.805(95%CI 0.742-0.868;P<0.001).When the optimal cut-off value of hs-CRP was 5.54 mg/L,the sensitivity and specificity of predicting SAP were 76.11%and 76.19%,respectively.The analysis of nomogram also showed that hs-CRP was an independent predictor of SAP(consistency index 0.862,95%CI 0.738-0.986;P<0.001).Conclusions The increased serum hs-CRP was an independent predictor of SAP in patients with AIS receiving intravenous thrombolysis,and had a higher predictive value.