目的:探讨白细胞介素-6(IL-6)联合中性粒细胞脂质运载蛋白(HNL)对急性缺血性脑卒中(AIS)患者卒中相关性肺炎(SAP)的预测价值。
方法:108例患者分为肺炎组(52例)和非肺炎组(56例),根据患者在入院后7天内是否发生SAP。比较两组的一般资料,像年龄,性别,高血压病史,糖尿病,心血管疾病,吞咽困难,有吸烟和酗酒史。记录并比较临床资料,包括脂质分布,白细胞介素-6(IL-6),同型半胱氨酸(Hcy),美国国立卫生研究院卒中量表(NIHSS)评分,和HNL。采用多因素Logistic回归分析筛选AIS-AP的危险因素,并通过受试者工作特征曲线(ROC曲线)评估IL-6和HNL单独和组合的预测价值。
结果:Logistic回归分析显示吞咽困难(OR,0.018;95%CI,0.001~0.427;P=0.013),NIHSS分数增加(或,0.012;95%CI,0.000~0.434;P=0.016),和高水平的IL-6(OR,0.014;95%CI,0.000~0.695;P=0.032)和HNL(OR,0.006;95%CI0.000~0.280;P=0.009)是SAP的独立危险因素,差异均有统计学意义(均P<0.05)。根据IL-6的ROC曲线分析,曲线下面积(AUC)为0.881(95%CI:0.820~0.942),最佳截断值为6.89pg/mL,灵敏度为73.1%,特异性为85.7%。至于HNL的ROC曲线分析,AUC为0.896(95%CI:0.839~0.954),最佳截断值为99.66ng/mL,灵敏度为76.9%,特异度为89.3%。IL-6和HNL联合用药的AUC升高至0.952(95%CI:0.914~0.989),敏感性和特异性分别提高到80.8%和92.9%,分别。
结论:在这项研究中,IL-6≥6.89pg/mL和HNL≥99.66ng/mL被认为是AIS患者并发SAP的危险因素.联合检测对SAP患者有较高的预测价值,这可能有助于确定谁是高风险的。
OBJECTIVE: To explore the predictive value of interleukin-6 (IL-6) combined with human neutrophil lipocalin (HNL) of stroke-associated pneumonia (SAP) in patients who were diagnosed with acute ischemic stroke (AIS).
METHODS: 108patients were divided into two groups: pneumonia group (52 cases) and non-pneumonia group (56 cases), according to whether the patients developed SAP within 7 days of admission. General information was compared between the two groups, like age, gender, history of hypertension, diabetes mellitus, cardiovascular disease, dysphagia, smoking and alcoholhistory. Clinical data were recorded and compared, including lipid profile, interleukin-6 (IL-6), homocysteine (Hcy), National Institutes of Health Stroke Scale (NIHSS) score, and HNL. Multivariate Logistic regression analysis was used to screen the risk factors of AIS-AP, and the predictive value of IL-6 and HNL alone and in combination was evaluated by receiver operating characteristic curve (ROC curve).
RESULTS: Logistic regression analysis showed that dysphagia (OR,0.018; 95% CI, 0.001 ~ 0.427; P = 0.013), increased NIHSS scores(OR,0.012; 95% CI, 0.000 ~ 0.434; P = 0.016), and high levels of IL-6 (OR,0.014; 95% CI, 0.000 ~ 0.695; P = 0.032)and HNL (OR,0.006; 95% CI, 0.000 ~ 0.280; P = 0.009) were independent risk factors for SAP with significant difference (all P < 0.05). According to the ROC curve analysis of IL-6, the area under the curve (AUC) was 0.881 (95% CI: 0.820 ~ 0.942), and the optimal cutoff value was 6.89 pg/mL with the sensitivity of 73.1% and specificity of 85.7%. As for the ROC curve analysis of HNL, the AUC was 0.896 (95% CI: 0.839 ~ 0.954), and the best cutoff value was 99.66ng/mL with the sensitivity of 76.9% and specificity of 89.3%. The AUC of the combination of IL-6 and HNL increased to 0.952 (95% CI: 0.914 ~ 0.989), and the sensitivity and specificity increased to 80.8% and 92.9%, respectively.
CONCLUSIONS: In this research, the levels of IL-6 ≥ 6.89 pg/mL and HNL ≥ 99.66ng/mL were considered as risk factors for AIS patients complicated with SAP. The combined detection had higher predictive value for patients with SAP, which may help to identify who were in highrisk.