血清肾上腺髓质素前体对急性脑梗死并发卒中相关性肺炎的预测价值

浦晋军; 罗家祺; 周丹丹; 缪从良; 方伯初; 孙燕妮

doi:10.7619/jcmp.202005013

血清肾上腺髓质素前体对急性脑梗死并发卒中相关性肺炎的预测价值

上海中医药大学附属普陀医院, 1. 急诊内科;
2. 中医内科, 上海, 200062;
3. 上海交通大学附属第一人民医院急诊危重病科, 上海, 200080

基金项目:

上海中医药大学附属普陀医院院级课题(2017312B)

详细信息

通讯作者:
孙燕妮,E-mail:18917196903@163.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2019-12-07
- 网络出版日期: 2020-08-26

Predictive value of serum proadrenomedullin in acute cerebral infarction patients with stroke-associated pneumonia

1. Internal Medical Department of Emergency;
2. Internal Medical Department of Traditional Chinese Medicine, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200062;
3. Department of Emergency and Critical Care Medicine, The First Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200080

摘要

摘要: 目的探讨血清肾上腺髓质素前体(pro-ADM)水平对急性脑梗死并发卒中相关性肺炎(SAP)的预测价值。方法前瞻性选取100例急性脑梗死患者作为研究对象,根据临床症状及微生物培养结果将患者分为SAP组和非SAP组,并记录诊断SAP的时间。在患者入院后第1、3、5天,采用ELISA法测定其血清pro-ADM水平,运用受试者工作特征(ROC)曲线分析pro-ADM对SAP的预测价值,在第3天和第5天检验前已确诊患者不纳入分析。对入院时美国国立卫生研究院卒中量表(NIHSS)评分≥10分患者中SAP组和非SAP组在不同时点的pro-ADM水平进行比较。采用多因素Logistic回归分析SAP的危险因素。结果入院后第1、3、5天,SAP组pro-ADM水平分别为(1.74±0.39)、(1.44±0.44)、(1.56±0.47)nmol/L,分别高于非SAP组(1.30±0.33)、(1.23±0.42)、(1.13±0.39)nmol/L,差异均有统计学意义(P<0.05 或P<0.01)。pro-ADM在入院后第1、3、5天预测SAP的ROC曲线下面积分别为0.807(95%CI为0.724~0.890)、0.636(95%CI为0.521~0.751)、0.760(95%CI为0.645~0.875)。入院后第1、5天,入院时NIHSS评分≥10分患者中的SAP组pro-ADM水平为(1.71±0.37)、(1.55±0.49)nmol/L,显著高于非SAP组的(1.48±0.34)、(1.24±0.34)nmol/L(P<0.05)。多因素Logistic回归分析显示,入院第1天高NIHSS评分和高血清pro-ADM水平是SAP发生的危险因素。结论在急性脑梗死早期检测血清pro-ADM水平可能有助于预测SAP的发生。
- 肾上腺髓质素前体 /
- 脑梗死 /
- 卒中相关性肺炎 /
- 美国国立卫生研究院卒中量表 /
- 预测
Abstract: Objective To investigate the predictive value of serum proadrenomedullin(pro-ADM)level in acute cerebral infarction patients with stroke-associated pneumonia(SAP). Methods A total of 100 patients with acute cerebral infarction were selected and divided into SAP group(n=43)and non-SAP group(n=57)according to the clinical symptoms and microbiological culture results, and the time to diagnosis of SAP was recorded. The levels of serum pro-ADM were measured by ELISA on 1^st, 3^rd and 5^th day after admission. The predictive value of pro-ADM for SAP was assessed by receiver operating characteristic(ROC)curve analysis. The results of patients diagnosed as SAP on the 3^rd and 5^th day before the assay were not included in the predictive analysis. The pro-ADM levels of patients with NIHSS score≥10 at admission in SAP group and non-SAP group were compared. Multivariable logistic regression was applied to investigate risk factors for the progression of SAP. Results On the 1^st, 3^rd and 5^th day after hospital admission, the pro-ADM levels were(1.74±0.39),(1.44±0.44)and(1.56±0.47)nmol/L respectively in the SAP group, which were significantly - higher than(1.30±0.33),(1.23±0.42)and(1.13±0.39)nmol/L in non-SAP group(P<0.05 or P<0.01). For diagnosis of SAP, the area under the ROC curve( AUC)for pro-ADM on 1^st, 3^rd and 5^th were 0.807(95% CI was 0.724 to 0.890), 0.636(95% CI was 0.521 to 0.751)and 0.760(95% CI was 0.645 to 0.875), respectively. On the 1^st and 5^th day, the pro-ADM levels of patients with NIHSS score≥10 at admission were(1.71±0.37)and(1.55±0.49)nmol/L in SAP group, which were significantly higher than(1.48±0.34)and(1.24±0.34)nmol/L in non-SAP Group(P<0.05). The multivariable logistic regression analysis showed that a higher NIHSS score and a higher serum pro-ADM level on 1^st day after hospital admission were the risk factors for SAP. Conclusion The detection of serum pro-ADM level in the early stage of acute cerebral infarction may be helpful to predict the occurrence of SAP.
- proadrenomedullin /
- cerebral infarction /
- stroke-associated pneumonia /
- National Institutes of Health Stroke Scale /
- prediction

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参考文献(20)

Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine[J]. Stroke, 2003, 34(4): 975-981.

Lopes M, Freitas E, Oliveira M, et al. Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke[J]. Eur J Neurol, 2019, 26(5): 722-726.

Santos Samary C, Pelosi P, Leme Silva P, et al. Immunomodulation after ischemic stroke: potential mechanisms and implications for therapy[J]. Crit Care, 2016, 20(1): 391-398.

Bustamante A, Vilar-Bergua A, Guettier S, et al. C-reactive protein in the detection of post-stroke infections: systematic review and individual participant data analysis[J]. J Neurochem, 2017, 141(2): 305-314.

Hug A, Mürle B, Dalpke A, et al. Usefulness of serum procalcitonin levels for the early diagnosis of stroke-associated respiratory tract infections[J]. Neurocrit Care, 2011, 14(3): 416-422.

Menéndez R, Méndez R, Almansa R, et al. Simultaneous depression of immunological synapse and endothelial injury is associated with organ dysfunction in community-acquired pneumonia[J]. J Clin Med, 2019, 8(9): E1404-E1411.

中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4): 246-257.

卒中相关性肺炎诊治中国专家共识组. 卒中相关性肺炎诊治中国专家共识[J]. 中华内科杂志, 2010, 49(12): 1075-1078.

Teh W H, Smith C J, Barlas R S, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome[J]. Acta Neurol Scand, 2018, 138(4): 293-300.

Fluri F, Morgenthaler N G, Mueller B, et al. Copeptin, procalcitonin and routine inflammatory markers-predictors of infection after stroke[J]. PLoS One, 2012, 7(10): e48309.

Emsley H C, Smith C J, Gavin C M, et al. An early and sustained peripheral inflammatory response in acute ischaemic stroke: relationships with infection and atherosclerosis[J]. J Neuroimmunol, 2003, 139(1/2): 93-101.

Caironi P, Latini R, Struck J, et al. Circulating biologically active adrenomedullin(bio-ADM)predicts hemodynamic support requirement and mortality during Sepsis[J]. Chest, 2017, 152(2): 312-320.

El Haddad H, Chaftari A M, Hachem R, et al. Biomarkers of Sepsis and bloodstream infections: the role of procalcitonin and proadrenomedullin with emphasis in patients with cancer[J]. Clin Infect Dis, 2018, 67(6): 971-977.

Menéndez R, Méndez R, Aldás I, et al. Community-acquired pneumonia patients at risk for early and long-term cardiovascular events are identified by cardiac biomarkers[J]. Chest, 2019, 156(6): 1080-1091.

Alcoba G, Manzano S, Lacroix L, et al. Proadrenomedullin and copeptin in pediatric pneumonia: a prospective diagnostic accuracy study[J]. BMC Infect Dis, 2015, 15: 347-353.

España P P, Capelastegui A, Mar C, et al. Performance of pro-adrenomedullin for identifying adverse outcomes in community-acquired pneumonia[J]. J Infect, 2015, 70(5): 457-466.

Florkowski C M. Sensitivity, specificity, receiver-operating characteristic(ROC)curves and likelihood ratios: communicating the performance of diagnostic tests[J]. Clin Biochem Rev, 2008, 29(Suppl 1): S83-S87.

Friedant A J, Gouse B M, Boehme A K, et al. A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2015, 24(3): 680-686.

Schober P, Boer C, Schwarte L A. Correlation coefficients: appropriate use and interpretation[J]. Anesth Analg, 2018, 126(5): 1763-1768.

Smith C J, Kishore A K, Vail A, et al. Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group[J]. Stroke, 2015, 46(8): 2335-2340.

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