發(fā)布時(shí)間：2018-07-17 06:15

【摘要】：目的:探索A~2DS~2評分聯(lián)合血糖后是否可以提高對急性缺血性腦卒中患者卒中相關(guān)性肺炎(SAP)發(fā)生風(fēng)險(xiǎn)的預(yù)測價(jià)值。方法:回顧性連續(xù)收集2012年1月至2016年12月山西醫(yī)科大學(xué)第一醫(yī)院神經(jīng)內(nèi)科收治的在發(fā)病7天內(nèi)入院的急性缺血性腦卒中患者的病例資料,包括年齡、性別、房顫、吞咽困難、NIHSS評分、入院血糖、空腹血糖和梗死部位,并計(jì)算A~2DS~2評分。對所有納入對象采用改良CDC標(biāo)準(zhǔn)或Mann’s標(biāo)準(zhǔn)診斷SAP。多元Logistic回歸分析計(jì)算入院高血糖(≥11.1mmol/L)、空腹高血糖(≥7.1mmol/L)、入院或空腹高血糖的調(diào)整OR值并確定血糖預(yù)測SAP發(fā)生風(fēng)險(xiǎn)的分值,與A~2DS~2評分聯(lián)合生成新的評分量表。用ROC曲線分析分別繪制A~2DS~2評分和新評分量表的ROC曲線圖,并計(jì)算A~2DS~2評分和m A~2DS~2評分的曲線下面積(AUC),AUC0.5表示有預(yù)測價(jià)值,比較A~2DS~2評分和m A~2DS~2評分的AUC,AUC越大,預(yù)測價(jià)值越高。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。并計(jì)算各自的最佳截?cái)嘀档撵`敏度和特異度。結(jié)果:共納入符合標(biāo)準(zhǔn)的急性缺血性腦卒中患者2552例,平均年齡61.85(±12.70)歲,肺炎發(fā)病率7.8%。入院高血糖、空腹高血糖、入院/空腹高血糖對SAP的調(diào)整OR值分別是1.04(P=0.885)、2.86(P0.05)、1.14(P=0.475)�？崭垢哐鞘荢AP的獨(dú)立危險(xiǎn)因素,其調(diào)整OR值在2-4之間,賦值2分,與A~2DS~2評分聯(lián)合后生成改良A~2DS~2評分(mA~2DS~2評分)。A~2DS~2評分和mA~2DS~2評分的分值越高,SAP的發(fā)病率也越高。A~2DS~2評分和mA~2DS~2評分的AUC(95%CI)分別是0.793(0.777,0.809)和0.814(0.798,0.828),且mA~2DS~2評分的AUC大于A~2DS~2評分(Z=2.704,P0.05),差異有統(tǒng)計(jì)學(xué)意義。在本研究中,A~2DS~2評分的最佳截?cái)嘀凳?分,靈敏度81.5%,特異度62.2%,mA~2DS~2評分的最佳截?cái)嘀凳?分,靈敏度83.5%,特異度64.9%。結(jié)論:1.空腹高血糖是SAP的獨(dú)立危險(xiǎn)因素;2.在本研究中,A~2DS~2評分和mA~2DS~2評分都是簡便有效的急性缺血性腦卒中患者SAP發(fā)生風(fēng)險(xiǎn)的預(yù)測評分量表;3.在本研究中,mA~2DS~2評分對SAP發(fā)生風(fēng)險(xiǎn)的預(yù)測價(jià)值優(yōu)于A~2DS~2評分。
[Abstract]:Objective: to explore whether the combination of A2 DS2 score and blood glucose can improve the predictive value of acute ischemic stroke patients with stroke associated pneumonia (SAP). Methods: data of patients with acute ischemic stroke admitted within 7 days from January 2012 to December 2016 in the Department of Neurology, first Hospital of Shanxi Medical University, including age, sex, atrial fibrillation, were collected retrospectively. NIHSS, admission blood glucose, fasting blood glucose and infarct location were evaluated. All subjects were diagnosed with improved CDC criteria or Mannus criteria. Multivariate logistic regression analysis was used to calculate admission hyperglycemia (鈮，

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