中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

ICU 老年脑卒中患者卒中相关性肺炎危险因素以及单核细胞 HLA-DR 预测价值分析

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目的 探讨重症监护病房(ICU)老年脑卒中患者卒中相关性肺炎(SAP)的危险因素,以及单核细胞人类白细胞抗原(HLA-DR)对 SAP 的预测价值。 方法 选择 2015 年 1 月至 2016 年 8 月 ICU 住院的老年脑卒中患者 155 例,入院后进行单核细胞 HLA-DR 检测,统计其 SAP 发生率,进行单因素和多因素分析 SAP 相关危险因素。绘制单核细胞 HLA-DR 受试者工作特征(ROC)曲线,分析单核细胞 HLA-DR 对 SAP 的预测价值。 结果 155 例患者中 75 例发生 SAP,SAP 发生率为 48.4%,其中早发型 42 例,晚发型 33 例。年龄(OR=11.532)、格拉斯哥昏迷评分(OR=7.124)、吞咽障碍(OR=8.846)、机械通气(OR=15.184)、心房颤动(OR=7.869)、吸烟史(OR=11.784)、糖尿病(OR=7.185)是 ICU 老年脑卒中患者 SAP 的独立危险因素(均 P<0.05)。SAP 患者单核细胞 HLA-DR 表达显著低于非 SAP 患者(P<0.05),ROC 曲线确定 HLA-DR 表达率低于 78.65% 为预测 SAP 最佳诊断截断值,ROC 曲线下面积为 0.922,敏感性为 80.0%,特异性为 85.0%,其中预测早发型 SAP 的敏感性为 90.5%(38/42),预测晚发型 SAP 的敏感性为 66.7%(22/33)。 结论 高龄、重度昏迷、吞咽障碍、机械通气、心房颤动、吸烟史及糖尿病是诱发 ICU 老年脑卒中患者 SAP 的危险因素。检测单核细胞 HLA-DR 表达对早期预测 SAP 具有参考价值,其中对早发型 SAP 预测敏感性较高。

Objective To explore risk factors of stroke-associated pneumonia (SAP) for elderly stroke patients in ICU, and analyze the predictive value of human leukocyte antigen-DR (HLA-DR) on monocytes for SAP. Methods During January 2015 to August 2016, 155 elderly patients with stroke were recruited. The level of monocyte HLA-DR expression was measured after admission and the incidence of SAP was recorded. The risk factors for SAP were analyzed by univariate and multivariate analysis. ROC curve was drawn to analyze prognostic value of HLA-DR. Results SAP occurred in 75 cases with occurrence rate of 48.4%, including 42 early-onset cases and 33 later-onset cases. Age (OR=11.532), Glasgow Coma Scale (OR=7.124), dysphagia (OR=8.846), mechanical ventilation (OR=15.184), atrial fibrillation (OR=7.869), smoking history (OR=11.784), diabetes (OR=7.185) were independent risk factors (all P<0.05). The expression rate of monocyte HLA-DR in the SAP patients was significantly lower than those in the patients without SAP (allP<0.05). Through the ROC curve analysis, the expression rate of HLA-DR that below 78.65% was the optimum cut-off value for prediction of SAP with the area under ROC curve of 0.922, the sensitivity of 80.0% and the specificity of 85.0%. The sensitivity to predict early-onset SAP was 90.5% (38/42), and to predict later-onset SAP was 66.7% (22/33). Conclusions Age, severe coma, dysphagia, mechanical ventilation, atrial fibrillation, smoking history and diabetes are risk factors for SAP in elderly stroke patients in ICU. The detection of monocyte HLA-DR has reference value for early prediction of SAP especially for early-onset SAP with higher sensitivity.

关键词: 脑卒中; 卒中相关性肺炎; 危险因素; 单核细胞; 人类白细胞抗原

Key words: Stroke; Stroke-associated pneumonia; Risk factors; Monocytes; Human leukocyte antigen

引用本文: 石彦杰, 郑惠, 王二玲, 郑春雷, 刘晓刚. ICU 老年脑卒中患者卒中相关性肺炎危险因素以及单核细胞 HLA-DR 预测价值分析. 中国呼吸与危重监护杂志, 2018, 17(1): 51-54. doi: 10.7507/1671-6205.201611008 复制

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