CAJ | 학술논문

目的：探讨β1－受体阻滞剂治疗脑卒中后对患者感染和死亡率的影响。方法本研究是前瞻性队列研究，将2012－01～2014－06在我院神经内科接受治疗的125例急性脑卒中患者纳入研究，根据患者是否服用β1－受体阻滞剂将患者分为β1－受体阻滞剂组60例（治疗组）与无β1－受体阻滞剂组65例（对照组），使用流式细胞仪检测患者iNKT细胞值，利用多变量Poisson过程和Cox回归模型分析β1－受体阻滞剂治疗对脑卒中后肺炎、尿路感染和死亡率的影响。结果110例（88．3％）患者是缺血性脑卒中，15例（11．7％）患者是出血性脑卒中。神经功能缺损评分（NIHSS）基线值为8分（5～16分）。60例（48．2％）患者接受β1－受体阻滞剂治疗。β1－受体阻滞剂治疗对脑卒中后患者肺炎的发生没有影响，差异无统计学意义（ RR＝1．00，95％CI 0．77～1．30，P＝0.995）。而β1－受体阻滞剂治疗患者尿路感染的风险明显降低（RR＝0．65，95％CI 0．43～0.98，P＝0．040）。7 d死亡率差异无统计学意义（RR＝1．36，95％CI 0．65～2．77， P＝0．425），而β1－受体阻滞剂治疗患者30 d死亡率较高（ HR＝1．93，95％ CI 1．20～3．10， P＝0.006）。治疗组肺炎患者亚组与尿路感染亚组患者iNKT细胞值的组内差异无统计学意义，组间比较尿路感染亚组的iNKT细胞较低（P＜0．05）。结论β1－受体阻滞剂治疗不能减少患者卒中后发生肺炎的危险，但能显著降低尿路感染的风险。
목적：탐토β1－수체조체제치료뇌졸중후대환자감염화사망솔적영향。방법본연구시전첨성대렬연구，장2012－01～2014－06재아원신경내과접수치료적125례급성뇌졸중환자납입연구，근거환자시부복용β1－수체조체제장환자분위β1－수체조체제조60례（치료조）여무β1－수체조체제조65례（대조조），사용류식세포의검측환자iNKT세포치，이용다변량Poisson과정화Cox회귀모형분석β1－수체조체제치료대뇌졸중후폐염、뇨로감염화사망솔적영향。결과110례（88．3％）환자시결혈성뇌졸중，15례（11．7％）환자시출혈성뇌졸중。신경공능결손평분（NIHSS）기선치위8분（5～16분）。60례（48．2％）환자접수β1－수체조체제치료。β1－수체조체제치료대뇌졸중후환자폐염적발생몰유영향，차이무통계학의의（ RR＝1．00，95％CI 0．77～1．30，P＝0.995）。이β1－수체조체제치료환자뇨로감염적풍험명현강저（RR＝0．65，95％CI 0．43～0.98，P＝0．040）。7 d사망솔차이무통계학의의（RR＝1．36，95％CI 0．65～2．77， P＝0．425），이β1－수체조체제치료환자30 d사망솔교고（ HR＝1．93，95％ CI 1．20～3．10， P＝0.006）。치료조폐염환자아조여뇨로감염아조환자iNKT세포치적조내차이무통계학의의，조간비교뇨로감염아조적iNKT세포교저（P＜0．05）。결론β1－수체조체제치료불능감소환자졸중후발생폐염적위험，단능현저강저뇨로감염적풍험。
Objective To investigate the effect of β1 -blocker therapy on the risk of infections and death after stroke in human .Methods A total of 125 patients with ischemic or hemorrhagic stroke , admitted to our hospital stroke unit from 2012 January to 2014 June, were included in this historical cohort study .Subjects were divided into β1 -blocker group ( therapy group ) and no -β1 -Blocker ( control group ) .iNKT value was detected in patients by flow cytometry .The effect of β1 -blocker therapy on post -stroke pneumonia , urinary tract infections and death was investigated using multivariable Poisson and Cox regression models .Results One hundred and ten (88.3%) patients were admitted with ischemic stroke, the remaining 15 (11.7%) patients had a hemorrhagic stroke. Median baseline NIHSS was 8 ( 5 ~16 ) points.Sixty ( 48.2%) patients received beta -blocker therapy .There was no difference in the risk of post -stroke pneumonia between patients with and withoutβ1 -blocker therapy (RR=1.00, 95% CI 0.77 ~1.30, P=0.995).Patients with β1 -blocker therapy showed a decreased risk for urinary tract infections ( RR=0.65, 95% CI 0.43~0.98, P=0.040).7-days mortality did not differ between groups (HR =1.36, 95% CI 0.65 ~2.77, P=0.425), while patients with β1 -blocker therapy showed a higher 30 -days mortality (HR=1.93, 95%CI 1.20~3.10, P=0.006).There was no significant difference in iNKT values between the patients with pneumonia and urinary tract infection , and the iNKT value in the urinary tract infection group was significantly lower than the pneumonia group (P<0.05).Conclusion β1 -blocker therapy does not reduce the risk for post -stroke pneumonia , but significantly reduces the risk for urinary tract infections .