目的:探讨A2DS2评分联合中性粒细胞百分比/白蛋白比值(neutrophil percentage/albumin ratio,NPAR)、D-二聚体对急性缺血性脑卒中(acute ischemic stroke,AIS)患者发生卒中相关性肺炎(stroke-associated pneumonia,SAP)的预测价值。方法...目的:探讨A2DS2评分联合中性粒细胞百分比/白蛋白比值(neutrophil percentage/albumin ratio,NPAR)、D-二聚体对急性缺血性脑卒中(acute ischemic stroke,AIS)患者发生卒中相关性肺炎(stroke-associated pneumonia,SAP)的预测价值。方法:回顾性分析南部战区空军医院2017年11月至2023年11月期间收治的265例AIS患者的临床资料,根据AIS患者发病1周内是否发生SAP分为SAP组和非SAP组,收集两组患者的临床资料,计算A2DS2评分、NPAR,检测两组D-二聚体水平。Spearman相关性分析A2DS2评分与NPAR、D-二聚体水平的关系。采用多因素Logistic回归分析独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评价预测价值。基于A2DS2评分、NPAR和D-二聚体的最佳截断值构建改良A2DS2(modifed A2DS2,mA2DS2)评分,应用ROC曲线分析mA2DS2评分对AIS患者发生SAP的预测价值。结果:本次研究共纳入265例AIS患者,其中78例AIS患者发病1周内发生SAP,SAP发病率为29.43%。SAP组和非SAP组在年龄、入院时美国国立卫生院研究卒中量表(national institute of health stroke scale,NIHSS)评分、吞咽困难、心房纤颤、既往卒中史、A2DS2评分、D-二聚体、纤维蛋白原水平、全身免疫炎症指数(systemic immune-inflammation index,SII)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板/淋巴细胞的比值(platelet to lymphocyte ratio,PLR)、NPAR等方面比较有差异(P<0.05)。A2DS2评分与NPAR、D-二聚体呈正相关(P<0.05)。NPAR升高、D-二聚体升高、A2DS2评分升高是AIS患者发生SAP的危险因素(P<0.05)。A2DS2评分预测AIS患者发生SAP的曲线下面积(area under curve,AUC)为0.866,NPAR预测AIS患者发生SAP的AUC为0.815,D-二聚体预测发生SAP的AUC为0.705。ROC曲线分析结果显示,mA2DS2评分预测AIS患者发生SAP的AUC为0.898,大于A2DS2评分单独预测的AUC(Z=3.557,P<0.05)。结论:A2DS2评分、NPAR、D-二聚体水平显著升高与AIS患者发生SAP有关,A2DS2评分联合NPAR、D-二聚体检测对AIS患者发生SAP的预测效能较高。展开更多
BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS...BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than that in the score 1–9 and score 0 groups(16.7% vs. 4.96%,16.7% vs. 0.3%,respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA,ACA distribution areas were signif icantly higher than those in the SAP group and in the non-SAP group(35.1% vs.10.1%,11.4% vs. 7.5%,respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS:A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.展开更多
文摘目的:探讨A2DS2评分联合中性粒细胞百分比/白蛋白比值(neutrophil percentage/albumin ratio,NPAR)、D-二聚体对急性缺血性脑卒中(acute ischemic stroke,AIS)患者发生卒中相关性肺炎(stroke-associated pneumonia,SAP)的预测价值。方法:回顾性分析南部战区空军医院2017年11月至2023年11月期间收治的265例AIS患者的临床资料,根据AIS患者发病1周内是否发生SAP分为SAP组和非SAP组,收集两组患者的临床资料,计算A2DS2评分、NPAR,检测两组D-二聚体水平。Spearman相关性分析A2DS2评分与NPAR、D-二聚体水平的关系。采用多因素Logistic回归分析独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评价预测价值。基于A2DS2评分、NPAR和D-二聚体的最佳截断值构建改良A2DS2(modifed A2DS2,mA2DS2)评分,应用ROC曲线分析mA2DS2评分对AIS患者发生SAP的预测价值。结果:本次研究共纳入265例AIS患者,其中78例AIS患者发病1周内发生SAP,SAP发病率为29.43%。SAP组和非SAP组在年龄、入院时美国国立卫生院研究卒中量表(national institute of health stroke scale,NIHSS)评分、吞咽困难、心房纤颤、既往卒中史、A2DS2评分、D-二聚体、纤维蛋白原水平、全身免疫炎症指数(systemic immune-inflammation index,SII)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板/淋巴细胞的比值(platelet to lymphocyte ratio,PLR)、NPAR等方面比较有差异(P<0.05)。A2DS2评分与NPAR、D-二聚体呈正相关(P<0.05)。NPAR升高、D-二聚体升高、A2DS2评分升高是AIS患者发生SAP的危险因素(P<0.05)。A2DS2评分预测AIS患者发生SAP的曲线下面积(area under curve,AUC)为0.866,NPAR预测AIS患者发生SAP的AUC为0.815,D-二聚体预测发生SAP的AUC为0.705。ROC曲线分析结果显示,mA2DS2评分预测AIS患者发生SAP的AUC为0.898,大于A2DS2评分单独预测的AUC(Z=3.557,P<0.05)。结论:A2DS2评分、NPAR、D-二聚体水平显著升高与AIS患者发生SAP有关,A2DS2评分联合NPAR、D-二聚体检测对AIS患者发生SAP的预测效能较高。
文摘BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than that in the score 1–9 and score 0 groups(16.7% vs. 4.96%,16.7% vs. 0.3%,respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA,ACA distribution areas were signif icantly higher than those in the SAP group and in the non-SAP group(35.1% vs.10.1%,11.4% vs. 7.5%,respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS:A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.
