CAJ | 학술논문

目的：探讨老年人群卒中后肺炎发生的危险因素，并应用A2DS2评分预测老年人群卒中后肺炎的发生。方法采用回顾性调查方法，对2007年1月~2012年12月在我院神经内科住院时间超过24 h的60岁以上老年男性卒中患者肺炎进行临床资料采集分析。并应用工作特征曲线（ROC）曲线分析方法评价A2DS2评分预测老年卒中后肺炎发生的风险，应用Hosmer-Lemeshow拟合优度检验该评分的校准度。结果共纳入131例老年男性卒中病例，卒中后肺炎发生率为29.01%。卒中所致神经功能障碍为中（P=0.0081，OR：5.6089；95%CI：1.5663-20.0854）、重度（P=0.0048，OR：44.4827；95%CI：3.1847-621.3126）、吞咽困难（P=0.0005，OR：7.5265；95%CI：2.4282-23.3292）、房颤（P=0.0226，OR：4.1778；95%CI：1.2221-14.2825）均为卒中后肺炎的独立危险因素。A2DS2评分小于3分者卒中后肺炎发生率仅为2.2%，而8分以上者发生率则升至75%。ROC曲线分析表明，老年人群卒中后肺炎A2DS2评分的C值为0.86（95%CI 0.784-0.911）。Hosmer-Lemeshow拟合优度检验提示该评分对预测老年人群卒中后肺炎发生校准度较好（7.083，P=0.528）。结论早期识别卒中后肺炎的危险因素，应用A2DS2评分有效预测卒中病人发生肺炎的风险，对于防治卒中后肺炎有重要意义。
목적：탐토노년인군졸중후폐염발생적위험인소，병응용A2DS2평분예측노년인군졸중후폐염적발생。방법채용회고성조사방법，대2007년1월~2012년12월재아원신경내과주원시간초과24 h적60세이상노년남성졸중환자폐염진행림상자료채집분석。병응용공작특정곡선（ROC）곡선분석방법평개A2DS2평분예측노년졸중후폐염발생적풍험，응용Hosmer-Lemeshow의합우도검험해평분적교준도。결과공납입131례노년남성졸중병례，졸중후폐염발생솔위29.01%。졸중소치신경공능장애위중（P=0.0081，OR：5.6089；95%CI：1.5663-20.0854）、중도（P=0.0048，OR：44.4827；95%CI：3.1847-621.3126）、탄인곤난（P=0.0005，OR：7.5265；95%CI：2.4282-23.3292）、방전（P=0.0226，OR：4.1778；95%CI：1.2221-14.2825）균위졸중후폐염적독립위험인소。A2DS2평분소우3분자졸중후폐염발생솔부위2.2%，이8분이상자발생솔칙승지75%。ROC곡선분석표명，노년인군졸중후폐염A2DS2평분적C치위0.86（95%CI 0.784-0.911）。Hosmer-Lemeshow의합우도검험제시해평분대예측노년인군졸중후폐염발생교준도교호（7.083，P=0.528）。결론조기식별졸중후폐염적위험인소，응용A2DS2평분유효예측졸중병인발생폐염적풍험，대우방치졸중후폐염유중요의의。
Objective To investigate the risk factors for post-stroke pneumonia and assess the value of A2DS2 score in predicting post-stroke pneumonia in elderly stroke patients. Methods The clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A2DS2 score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis. The calibration of the score was analyzed using Hosmer-Lemeshow goodness-of-fit test. Results A total of 131 elderly male stroke patients were enrolled in this study, among whom the incidence of post-stroke pneumonia was 29.01%. The independent risk factors for post-stroke pneumonia identified included moderate (P=0.0081, OR: 5.6089; 95%CI: 1.5663-20.0854) and severe (P=0.0048, OR:44.4827;95%CI:3.1847-621.3126) neurological impairment, dysphagia (P=0.0005, OR:7.5265;95%CI: 2.4282-23.3292), and atrial fibrillation (P=0.0226, OR: 4.1778; 95%CI: 1.2221-14.2825). The incidence of post-stroke pneumonia ranged from 2.2% in patients with a A2DS2 score less than 3 to 75% in those with a score higher than 8. The C-statistic of A2DS2 score for predicting post-stroke pneumonia was 0.86 (95%CI: 0.784-0.911) by the ROC analysis. The A2DS2 score was well calibrated to predict post-stroke pneumonia in elderly patients by Hosmer-Lemeshow test (7.083, P=0.528). Conclusion The A2DS2 score can be useful for predicting post-stroke pneumonia and for routine monitoring of high-risk elderly stroke patients in the clinical setting.