国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2015年
3期
161-165
,共5页
尹琮煦%林镇洲%王胜男%彭郁%潘速跃
尹琮煦%林鎮洲%王勝男%彭鬱%潘速躍
윤종후%림진주%왕성남%팽욱%반속약
卒中%降钙素%肺炎,细菌性%脓毒症%危险因素%生物学标记
卒中%降鈣素%肺炎,細菌性%膿毒癥%危險因素%生物學標記
졸중%강개소%폐염,세균성%농독증%위험인소%생물학표기
Stroke%Calcitonin%Pneumonia,Bacterial%Sepsis%Risk Factors%Biological Markers
目的：探讨急性卒中患者发生细菌性肺炎的危险因素以及早期血清降钙素原(procalcitonin, PCT)水平对细菌性肺炎及脓毒症分级的预测价值。方法回顾性纳入神经重症监护病房急性卒中患者。根据有无细菌性肺炎分为细菌性肺炎组和无感染组,前者再根据脓毒症分级分为非严重脓毒症亚组和严重脓毒症亚组。比较人口统计学、基线临床资料和 PCT 水平(细菌性肺炎组为发生感染时 PCT 水平,无感染组为入院24 h内 PCT 水平)。采用多变量 logistic 回归分析确定细菌性肺炎的独立危险因素。采用受试者工作特征(receiver operator characteristic, ROC)曲线分析 PCT水平对细菌性肺炎和脓毒症分级的预测价值。结果共纳入164例急性卒中患者,细菌性肺炎组114例(非严重脓毒症亚组66例,严重脓毒症亚组48例),无感染组50例。细菌性肺炎组年龄、空腹血糖水平、格拉斯哥昏迷量表(Glasgow Coma Scale, GCS)评分和 PCT 水平与无感染组存在统计学差异(P 均<0．05)。多变量 logistic 回归分析显示,空腹血糖水平≥7 mmol/L[优势比( odds ratio, OR)8．488,95%可信区间(confidence interval, CI)2．739~26．300；P <0．01]、GCS 评分≤8分(OR 11．361,95% CI 2．175~59．352；P <0．01)、PCT≥0．050 ng/ml(OR 16．715,95% CI 5．075~55．049；P <0．01)为发生细菌性肺炎的独立危险因素。在细菌性肺炎组中,严重脓毒症亚组 PCT 水平[中位数(四分位间距)]显著高于非严重脓毒症亚组[0．835(0．164~1．715)ng/ml 对0．114(0．073~0．275)ng/ml；Z =-4．818,P <0．01]。 ROC 曲线分析表明,PCT≥0．070 ng/ml能较好地预测急性卒中患者发生细菌性肺炎,其敏感性为84．2%,特异性为74．0%,ROC 曲线下面积0．865(95% CI 0．806~0．924；P <0．01)；PCT≥0．669 ng/ml能较好地预测急性卒中合并细菌性肺炎患者发生严重脓毒症,其敏感性为56．3%,特异性为92．4%,ROC 曲线下面积0．765(95% CI 0．672~0．858；P <0．01)。结论急性卒中患者早期血清PCT≥0．050 ng/ml是发生细菌性肺炎的独立危险因素,其水平对细菌性肺炎和感染严重程度均具有一定的预测价值。
目的：探討急性卒中患者髮生細菌性肺炎的危險因素以及早期血清降鈣素原(procalcitonin, PCT)水平對細菌性肺炎及膿毒癥分級的預測價值。方法迴顧性納入神經重癥鑑護病房急性卒中患者。根據有無細菌性肺炎分為細菌性肺炎組和無感染組,前者再根據膿毒癥分級分為非嚴重膿毒癥亞組和嚴重膿毒癥亞組。比較人口統計學、基線臨床資料和 PCT 水平(細菌性肺炎組為髮生感染時 PCT 水平,無感染組為入院24 h內 PCT 水平)。採用多變量 logistic 迴歸分析確定細菌性肺炎的獨立危險因素。採用受試者工作特徵(receiver operator characteristic, ROC)麯線分析 PCT水平對細菌性肺炎和膿毒癥分級的預測價值。結果共納入164例急性卒中患者,細菌性肺炎組114例(非嚴重膿毒癥亞組66例,嚴重膿毒癥亞組48例),無感染組50例。細菌性肺炎組年齡、空腹血糖水平、格拉斯哥昏迷量錶(Glasgow Coma Scale, GCS)評分和 PCT 水平與無感染組存在統計學差異(P 均<0．05)。多變量 logistic 迴歸分析顯示,空腹血糖水平≥7 mmol/L[優勢比( odds ratio, OR)8．488,95%可信區間(confidence interval, CI)2．739~26．300；P <0．01]、GCS 評分≤8分(OR 11．361,95% CI 2．175~59．352；P <0．01)、PCT≥0．050 ng/ml(OR 16．715,95% CI 5．075~55．049；P <0．01)為髮生細菌性肺炎的獨立危險因素。在細菌性肺炎組中,嚴重膿毒癥亞組 PCT 水平[中位數(四分位間距)]顯著高于非嚴重膿毒癥亞組[0．835(0．164~1．715)ng/ml 對0．114(0．073~0．275)ng/ml；Z =-4．818,P <0．01]。 ROC 麯線分析錶明,PCT≥0．070 ng/ml能較好地預測急性卒中患者髮生細菌性肺炎,其敏感性為84．2%,特異性為74．0%,ROC 麯線下麵積0．865(95% CI 0．806~0．924；P <0．01)；PCT≥0．669 ng/ml能較好地預測急性卒中閤併細菌性肺炎患者髮生嚴重膿毒癥,其敏感性為56．3%,特異性為92．4%,ROC 麯線下麵積0．765(95% CI 0．672~0．858；P <0．01)。結論急性卒中患者早期血清PCT≥0．050 ng/ml是髮生細菌性肺炎的獨立危險因素,其水平對細菌性肺炎和感染嚴重程度均具有一定的預測價值。
목적：탐토급성졸중환자발생세균성폐염적위험인소이급조기혈청강개소원(procalcitonin, PCT)수평대세균성폐염급농독증분급적예측개치。방법회고성납입신경중증감호병방급성졸중환자。근거유무세균성폐염분위세균성폐염조화무감염조,전자재근거농독증분급분위비엄중농독증아조화엄중농독증아조。비교인구통계학、기선림상자료화 PCT 수평(세균성폐염조위발생감염시 PCT 수평,무감염조위입원24 h내 PCT 수평)。채용다변량 logistic 회귀분석학정세균성폐염적독립위험인소。채용수시자공작특정(receiver operator characteristic, ROC)곡선분석 PCT수평대세균성폐염화농독증분급적예측개치。결과공납입164례급성졸중환자,세균성폐염조114례(비엄중농독증아조66례,엄중농독증아조48례),무감염조50례。세균성폐염조년령、공복혈당수평、격랍사가혼미량표(Glasgow Coma Scale, GCS)평분화 PCT 수평여무감염조존재통계학차이(P 균<0．05)。다변량 logistic 회귀분석현시,공복혈당수평≥7 mmol/L[우세비( odds ratio, OR)8．488,95%가신구간(confidence interval, CI)2．739~26．300；P <0．01]、GCS 평분≤8분(OR 11．361,95% CI 2．175~59．352；P <0．01)、PCT≥0．050 ng/ml(OR 16．715,95% CI 5．075~55．049；P <0．01)위발생세균성폐염적독립위험인소。재세균성폐염조중,엄중농독증아조 PCT 수평[중위수(사분위간거)]현저고우비엄중농독증아조[0．835(0．164~1．715)ng/ml 대0．114(0．073~0．275)ng/ml；Z =-4．818,P <0．01]。 ROC 곡선분석표명,PCT≥0．070 ng/ml능교호지예측급성졸중환자발생세균성폐염,기민감성위84．2%,특이성위74．0%,ROC 곡선하면적0．865(95% CI 0．806~0．924；P <0．01)；PCT≥0．669 ng/ml능교호지예측급성졸중합병세균성폐염환자발생엄중농독증,기민감성위56．3%,특이성위92．4%,ROC 곡선하면적0．765(95% CI 0．672~0．858；P <0．01)。결론급성졸중환자조기혈청PCT≥0．050 ng/ml시발생세균성폐염적독립위험인소,기수평대세균성폐염화감염엄중정도균구유일정적예측개치。
Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin (PCT) level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level (the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission) were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis <br> classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group (66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup) and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale (GCS) score, and PCT level between the bacterial pneumonia group and the non-infection group (P < 0. 05 ). Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L (odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P < 0. 01), GCS score ≤8 (OR 11. 361, 95% CI 2. 175 - 59. 352; P < 0. 01), and PCT level ≥0. 050 ng/ml (OR 16. 715, CI 5. 075 - 55. 049; P < 0. 01) were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level (median; interquartile range) in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup (0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P < 0. 01 ). ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 (CI 0. 806 - 0. 924, P < 0. 01); PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 (CI 0. 672 - 0. 858; P < 0. 01). Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.
