摘要
目的分析脑梗死后遗症期合并社区获得性肺炎(CAP)患者影像学特征,构建和验证预后风险评分模型。方法选取2018年1月至2022年3月湖州学院附属南太湖医院和2012年1月至2021年12月陆军第72集团军医院诊治的216例脑梗死后遗症期合并CAP患者,采用随机数字表法,将216例患者按照7∶3的比例分为建模组(151例)和验证组(65例)。追踪住院期间患者是否死亡,将其分为死亡组和存活组。基于建模组数据,采用单因素和多因素logistic回归模型分析脑梗死后遗症期合并CAP患者预后的影响因素;根据多因素回归方程中各指标对应的回归系数,建立风险评分模型;使用受试者操作特征曲线评价模型效能,利用验证组数据对模型进行验证。结果216例脑梗死后遗症期合并CAP患者病死率为20.37%,建模组、验证组患者病死率分别为19.21%、23.08%。CT检查显示,脑梗死后遗症期合并CAP患者肺部感染累及单肺占72.69%,累及双肺占27.31%;CT检出肺实变占12.96%,检出胸腔积液占21.30%。死亡组和存活组年龄、发病至就诊时间、脑梗死病程、糖尿病、合并多重耐药革兰氏阴性菌(MDR-GNB)感染、中量及大量胸腔积液、中性粒细胞/淋巴细胞比值(NLR)、乳酸比较,差异有统计学意义(P<0.05)。脑梗死病程≥5年(OR=5.284)、糖尿病(OR=3.515)、合并MDR-GNB感染(OR=13.821)、中量及大量胸腔积液(OR=6.618)、NLR>5.85(OR=8.186)、乳酸>2.66 mmol/L(OR=4.699)是脑梗死后遗症期合并CAP患者预后的影响因素(P<0.05)。构建的风险评分模型在建模组和验证组中的曲线下面积分别为0.804(95%CI:0.731~0.864)、0.821(95%CI:0.706~0.905)。≥5分为死亡高风险人群。结论本研究构建的风险评分模型对于评估脑梗死后遗症期合并CAP患者预后具有良好的预测能力。
Objective To analyze the imaging features of patients in sequelae of cerebral infarction complicated with community acquired pneumonia(CAP),and to construct and validate prognostic risk score model.Methods A total of 216 sequelae of cerebral infarction complicated with CAP patients from South Taihu Hospital Affiliated to Huzhou College from January 2018 to March 2022 and the 72nd Military Hospital of Chinese People’s Liberation Army from January 2012 to December 2021 were selected.Using random number table method,216 patients were divided into modeling group(151 cases)and verification group(65 cases)according to the ratio of 7∶3.Death during hospitalization was tracked and divided into death group and survival group.Based on construction data,univariate and multivariate logistic regression were used to analyze the factors in prognosis of sequelae of cerebral infarction complicated with CAP patients;according to the regression coefficient corresponding to each index in the multi-factor regression equation,the risk score model was established;the performance of the model was evaluated by the receiver operating characteristic curve,and the model was validated by the verification group data.Results The fatality rate of 216 sequelae of cerebral infarction complicated with CAP patients was 20.37%,19.21%in modeling group and 23.08%in verification group.CT showed that the pulmonary infection involved only one lung in the sequelae of cerebral infarction complicated with CAP in 72.69%and both lungs in 27.31%.CT detected lung consolidation in 12.96%and pleural effusion in 21.30%.There were statistically significant differences in age,time from onset to treatment,duration of cerebral infarction,diabetes,mellitus combined with multidrug-resistant gram-negative bacteria(MDR-GNB)infection,moderate and large pleural effusions,neutrophil to lymphocyte ratio(NLR),and lactic acid between death group and survival group(P<0.05).Duration of cerebral infarction≥5 years(OR=5.284),diabetes mellitus(OR=3.515),combined with MDR-GNB i
作者
瞿恒娟
吴顺谊
黄小伟
叶永强
QU Hengjuan;WU Shunyi;HUANG Xiaowei;YE Yongqiang(Department of Radiology,South Taihu Hospital Affiliated to Huzhou College,Zhejiang Province,Huzhou313000,China;Department of Radiology,the 72nd Military Hospital of Chinese People’s Liberation Army,Zhejiang Province,Huzhou313000,China;Department of Respiratory,South Taihu Hospital Affiliated to Huzhou College,Zhejiang Province,Huzhou313000,China)
出处
《中国医药导报》
CAS
2023年第30期24-31,共8页
China Medical Herald
基金
浙江省医药卫生科技计划项目(2023XY172)。
关键词
脑梗死后遗症期
社区获得性肺炎
影像学特征
预后
风险评分模型
Sequelae of cerebral infarction
Community acquired pneumonia
Imaging features
Prognosis
Risk score model
