摘要
目的曾有研究将血清前白蛋白(PA)作为围手术期感染的预测指标,但外周血清前白蛋白(prealbumin,PA)水平能否作为缺血性卒中相关感染(stroke-associated infection,SAI)的一个指标尚不清楚。本研究旨在探讨血清PA与SAI的关系,为临床治疗提供理论依据。方法连续收集2018年1月-2019年3月入住安徽理工大学第一附属医院,淮南市第一人民医院神经内科的急性脑梗死患者310例,对住院的急性缺血性卒中患者进行血清PA测定。采用前瞻性研究方法,依据评估结果分为卒中相关感染(SAI)组(n=116)、非SAI组(n=154),观察PA对缺血性脑卒中患者发生SAI事件的预测价值。结果 310例患者中,73例(23. 5%)在随访7 d后发生SAI。SAI组的PA水平[192. 3 (162. 5~221. 9) mg/L]明显低于非SAI组[281. 7 (248. 4~337. 5) mg/L](P <0. 001)。预测SAI的最佳临界值为(PA≤229. 5 mg/L),敏感性为86. 5%,特异性为84. 9%。Kaplan-Meier生存分析显示低PA水平(PA≤229. 5 mg/L)的缺血性脑卒中患者SAI率较高(log-rank检验,χ^2=160. 71,P <0. 001)。COX回归分析显示(PA≤229. 5 mg/L)(hazard ratio=0. 076;95%CI,0. 039~0. 151,P <0. 001)是发生SAI的独立危险因素。结论血清前白蛋白可作为急性脑梗死相关感染的生物标志物。入院时血清前白蛋白水平降低与卒中相关感染有关,可能对于SAI早期诊断和临床干预具有重要意义。
Objective Several prior studies have linked serum prealbumin( PA) as a predictor for perioperative infection. However,whether peripheral blood PA levels can be used as an indicator of ischemic stroke-associated infection( SAI) is still unclear. The purpose of our study is to explore the relationship between prealbumin and ischemic stroke-associated infection,so as to provide theoretical basis for clinical treatment. Methods Consecutive patients with acute cerebral infarction who were admitted to our hospital were enrolled and serum PA was collected. A prospective study was conducted to observe the predictive value of PA in the SAI incident in ischemic stroke patients,and accordingly,they were divided into SAI group( n = 73) and non-SAI group( n = 237). Results 310 patients,73( 23. 5%) developed an SAI after 7 d of follow-up. The acute cerebral infarction with SAI group had significantly lower PA levels than the acute cerebral infarction without SAI group( P < 0. 05). The optimal cutoff value for predicting SAI was( PA ≤229. 5 mg/L),with sensitivity and specificity of 86. 5% and 84. 9%,respectively. Kaplan-Meier survival analysis showed that stroke patients with low serum PA level( PA ≤229. 5 mg/L) had a higher SAI rates( log-rank test,χ^2= 160. 71,P < 0. 001). Cox regression analysis showed that( PA ≤229. 5 mg/L)( hazard ratio = 0. 076;95% CI,0. 039 ~ 0. 151,P < 0. 001) was an independent risk factor for SAI. Conclusion Our results suggest that prealbumin may be used as potential diagnosis biomarkers for acute cerebral infarction-associated infection. Decreased prealbumin at admission are found to be correlated with acute cerebral infarction-associated infection and may have great significance in early diagnosis,intervention for SAI.
作者
李亚强
张梅
薛敏
LI Yaqiang;ZHANG Mei;XUE Min(Anhui University of Science and Technology,Huainan 232000,China)
出处
《中风与神经疾病杂志》
CAS
2019年第8期722-726,共5页
Journal of Apoplexy and Nervous Diseases
基金
安徽省科技攻关项目(No.12010402124)
关键词
前白蛋白
卒中
感染
Prealbumin
Stroke
Infection
