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血清炎症相关指标联合应用对脑卒中相关性肺炎的预测价值

Predictive value of combined application of serum inflammation-related indicators for stroke-associated pneumonia

    摘要
  • 摘要:
    目的 探究血清可溶性血红蛋白清道夫受体163(sCD163)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)联合对脑卒中相关性肺炎(SAP)的预测价值。
    方法 选取2021年10月—2023年1月在张家口市第一医院就诊的100例急性缺血性脑卒中患者为研究对象, 根据入院7 d内是否发生SAP, 将其分为SAP组(n=64)和非SAP组(n=36)。依据临床肺部感染严重指数(PSI)将SAP组患者分为SAP轻症组和SAP重症组。采用酶联免疫吸附试验(ELISA)检测血清sCD163、hs-CRP、PCT水平; 收集并比较患者临床资料; 采用Pearson法分析PSI评分与SAP患者血清sCD163、hs-CRP、PCT水平的相关性; 采用多因素Logistic回归分析筛选SAP发生的影响因素; 采用受试者工作特征(ROC)曲线分析血清sCD163、hs-CRP、PCT对SAP发生的预测效能。
    结果 SAP组吞咽障碍占比、NIHSS评分均高于非SAP组，差异有统计学意义(P < 0.05)。SAP组血清sCD163、hs-CRP、PCT水平均高于非SAP组，差异有统计学意义(P < 0.05)。SAP重症组血清sCD163、hs-CRP、PCT水平均高于SAP轻症组，差异有统计学意义(P < 0.05)。Pearson相关性分析结果表明, PSI评分与SAP患者血清sCD163、hs-CRP、PCT均呈正相关(r=0.356、0.413、0.391, P < 0.001)。Logistic回归分析结果显示，血清sCD163、hs-CRP、PCT、NIHSS评分及吞咽障碍均为SAP发生的影响因素(P < 0.05)。血清sCD163、hs-CRP、PCT以及三者联合预测SAP的曲线下面积(AUC)分别为0.842、0.924、0.866、0.973, 敏感度分别为73.44%、84.37%、67.19%、90.62%, 特异度分别为88.89%、83.33%、97.22%、94.44%; 三者联合预测较血清sCD163、hs-CRP、PCT单独预测的价值更优(Z三者联合-sCD163=3.520、Z三者联合-CRP=2.282, Z三者联合-PCT=3.149, P < 0.05)。
    结论 SAP患者血清sCD163、hs-CRP、PCT水平升高，其水平变化与病情程度密切相关，三者联合检测对SAP发生的预测价值较高，可能成为预测早期SAP发生的辅助标志物。

     

    Abstract:
    Objective To explore the predictive value of combined serum soluble hemoglobin scavenger receptor 163 (sCD163), hypersensitive C-reactive protein (hs-CRP), and procalcitonin (PCT) for stroke-associated pneumonia (SAP).
    Methods A total of 100 patients with acute ischemic stroke admitted to the First Hospital of Zhangjiakou from October 2021 to January 2023 were selected as the study subjects. According to whether they developed SPA within 7 days of admission, they were divided into SAP group (n= 64) and non-SAP group (n=36). Based on pneumonia severity index (PSI), patients in the SAP group were further divided into mild SAP group and severe SAP group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of sCD163, hs-CRP, and PCT. The clinical data of the patients were collected and compared. Pearson's method was used to analyze the correlation between the PSI score and the serum levels of sCD163, hs-CRP, and PCT in SAP patients. Multivariate Logistic regression analysis was employed to screen for factors influencing the occurrence of SAP. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive efficacy of serum sCD163, hs-CRP, and PCT for the occurrence of SAP.
    Results The proportion of patients with dysphagia and the National Institutes of Health Stroke Scale (NIHSS) score in the SAP group were significantly higher than those in the non-SAP group (P < 0.05). The serum levels of sCD163, hs-CRP, and PCT in the SAP group were significantly higher than those in the non-SAP group (P < 0.05). The serum levels of sCD163, hs-CRP, and PCT in the severe SAP group were significantly higher than those in the mild SAP group (P < 0.05). Pearson's correlation analysis showed that the PSI score was positively correlated with the serum levels of sCD163, hs-CRP and PCT in SAP patients (r=0.356, 0.413, 0.391, P < 0.001). Logistic regression analysis revealed that serum sCD163, hs-CRP, PCT, NIHSS score, and dysphagia were all influencing factors for the occurrence of SAP (P < 0.05). The areas under the curve (AUC) for predicting SAP using serum sCD163, hs-CRP, PCT and their combination were 0.842, 0.924, 0.866 and 0.973, respectively, with sensitivities of 73.44%, 84.37%, 67.19% and 90.62%, and specificities of 88.89%, 83.33%, 97.22% and 94.44%, respectively. The predictive value of the combined detection was superior to that of the individual detection of serum sCD163, hs-CRP and PCT (P < 0.05).
    Conclusion The serum levels of sCD163, hs-CRP, and PCT are elevated in SAP patients, and their changes are closely related to the severity of the disease. The combined detection of these three indicators has a high value in predicting the occurrence of SAP and may serve as auxiliary markers for predicting early SAP.

     

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