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乙酰胆碱酯酶和中性粒细胞与淋巴细胞比值对卒中相关性肺炎的预测价值

Value of acetylcholinesterase and neutrophil-to-lymphocyte ratio in predicting prognosis of stroke-associated pneumonia

    摘要
  • 摘要:
      目的  探讨急性脑梗死(ACI)患者乙酰胆碱酯酶(AChE)、中性粒细胞与淋巴细胞比值(NLR)及C反应蛋白(CRP)等指标对卒中相关性肺炎(SAP)的预测价值。
      方法  回顾性选取202例ACI患者为研究对象, 将发生SAP的105例患者纳入SAP组，将未发生SAP的97例患者纳入对照组。入院24 h内采集所有患者静脉血，检测AChE、NLR、CRP等指标水平，并评估患者美国国立卫生研究院卒中量表(NIHSS)评分。采用单因素和多因素Logistic回归分析探讨ACI患者发生SAP的危险因素，采用受试者工作特征(ROC)曲线分析AChE和NLR对SAP的预测价值，并比较不同AChE、NLR水平患者的病情严重程度和转归情况。
      结果  SAP组年龄、心房颤动者占比、中性粒细胞计数、NLR、AChE、NIHSS评分、病死率均高于对照组，住院时间长于对照组，淋巴细胞计数低于对照组，差异有统计学意义(P＜0.05或P＜0.01)。多因素Logistic回归分析结果显示, AChE风险比(HR)=0.99, 95%置信区间(CI)为0.98~1.00)、NLR(HR=3.10, 95%CI为1.89~5.10)均是SAP发生的独立影响因素。ROC曲线显示, AChE曲线下面积(AUC)=0.92, 截断值5 994.00 U/L, 敏感度88.60%, 特异度87.60%、NLR(AUC=0.93, 截断值4.43, 敏感度82.90%, 特异度91.80%)均对SAP风险有较高的预测价值，且AChE联合NLR的预测价值更高(AUC=0.98)。低AChE组NIHSS评分、病死率高于高AChE组，住院时间长于高AChE组，差异有统计学意义(P＜0.05); 高NLR组NIHSS评分高于低NLR组，住院时间长于低NLR组，差异有统计学意义(P＜0.05)。
      结论  血清AChE、NLR均与ACI患者SAP发病密切相关，二者联合应用对SAP风险具有重要的预测价值，且AChE、NLR水平可影响ACI严重程度和转归。

     

    Abstract:
      Objective  To explore the predictive value of acetylcholinesterase (AChE), neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) on stroke associated pneumonia (SAP) in patients with acute cerebral infarction (ACI).
      Methods  A total of 202 ACI patients were retrospectively enrolled as study objects, including 105 patients with SAP (SAP group) and 97 patients without SAP (control group). Venous blood was collected within 24 h of admission to detect the levels of AChE, NLR and CRP. The National Institutes of Health Stroke Scale (NIHSS) score was evaluated. Univariate and multivariate analyses were used to investigate the risk factors of SAP in ACI patients; Receiver Operating Characteristic (ROC) curve was used to analyze the predictive value of AChE and NLR for SAP; the severity and prognosis of patients with different AChE and NLR levels were compared.
      Results  Age, proportion of atrial fibrillation, neutrophil count, NLR, AChE, NIHSS score, and mortality rate in the SAP group were higher than those in the control group, while lymphocyte count was lower and hospital stay was longer than those in the control group (P < 0.05 or P < 0.01). Logistic regression results showed that AChEhazard ratio (HR)= 0.99, 95% confidence interval (CI), 0.98 to 1.00)and NLRHR=3.10, 95%CI, 1.89 to 5.10 were independent influencing factors of SAP. ROC curve analysis showed that AChE (area under the curve (AUC)=0.92, cut-off value of 5 994.00 U/L, sensitivity of 88.60%, specificity of 87.60%) and NLR (AUC=0.93, cut-off value of 4.43, sensitivity of 82.90%, specificity of 91.80%) were of high value in predicting risk of SAP, and the predictive value of AChE combined with NLR was higher (AUC=0.98). NIHSS score and mortality rate in the low AChE group were higher than those in the high AChE group, and hospital stay was longer than that in the high AChE group, the differences were statistically significant (P < 0.05). The NIHSS score of the high NLR group was higher than that of the low NLR group, and the length of hospital stay was longer than that of the low NLR group (P < 0.05).
      Conclusion  Serum AChE and NLR are closely related to the occurrence of SAP in ACI patients, and their combination has important clinical value for predicting the risk of SAP. In addition, AChE and NLR levels can affect severity and outcomes of ACI.

     

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