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不同评分量表在预测卒中相关性肺炎中的价值比较

Comparison of the value of different scoring scales in predicting risk of stroke-associated pneumonia

摘要目的:探讨A2DS2评分、ISAN评分、急性缺血性脑卒中相关性肺炎量表(AIS-APS)和不包含血肿体积的脑出血相关性肺炎预测量表(ICH-APS-A)在预测卒中相关性肺炎(SAP)中的价值。方法:回顾性分析2019年1—6月在徐州医科大学附属连云港医院住院的急性卒中患者304例。急性缺血性卒中(AIS)患者164例,其中合并SAP 82例;出血性卒中(ICH)患者140例,其中合并SAP 70例。卒中合并SAP患者为SAP组(152例),卒中未合并SAP患者为非SAP组(152例),采用受试者工作特征曲线下面积(AUC)比较四种评分的预测价值。结果:在预测SAP的发生时,与ISAN、AIS-APS和ICH-APS-A评分相比,A2DS2评分的AUC最大,其中在预测AIS发生SAP时,A2DS2评分的AUC(0.875,95% CI 0.815~0.922)大于AIS-APS评分和ISAN评分;在预测ICH发生SAP时,A2DS2评分的AUC(0.950,95% CI 0.900~0.980)大于ICH-APS-A评分和ISAN评分。在预测AIS和ICH发生SAP时,A2DS2评分的AUC明显高于ISAN评分[0.911(95% CI 0.873~0.94)比0.882(95% CI 0.840~0.916)],差异有统计学意义( Z=2.32, P<0.05)。在预测AIS发生SAP时,A2DS2、ISAN和AIS-APS评分均具有较好的预测价值,差异无统计学意义( P>0.05)。在预测ICH发生SAP时,A2DS2、ISAN和ICH-APS-A评分均具有较好的预测价值,差异无统计学意义( P>0.05)。 结论:在预测发生SAP时,A2DS2评分具有良好的预测价值,是一种可靠的预测工具。

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abstractsObjective:To explore the value of the age, atrial fibrillation, dysphagia, sex, stroke severity (A2DS2) score, the prestroke independence, sex, age, National Institutes of Health stroke scale (ISAN) score, acute ischemic stroke-associated pneumonia score (AIS-APS), and intracerebral hemorrhage associated pneumonia score without hematoma volume included (ICH-APS-A) in predicting risk of stroke-associated pneumonia (SAP).Methods:From January to June 2019, 304 patients with acute stroke who were hospitalized in the Lianyungang Hospital Affiliated to Xuzhou Medical University were analyzed retrospectively. There were 164 patients with acute ischemic stroke (AIS), including 82 patients with SAP. And there were 140 patients with intracerebral hemorrhage (ICH), including 70 patients with SAP. They were divided into SAP group (152 cases) and non-SAP group (152 cases) depending on whether they had SAP. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scores.Results:When predicting risk of SAP in patients with the stroke, the A2DS2 score had the largest AUC compared to the ISAN score, AIS-APS score, and ICH-APS-A score. When predicting risk of SAP in patients with AIS, the AUC (0.875, 95% CI 0.815 to 0.922) of the A2DS2 score was greater than the AIS-APS score and the ISAN score. When predicting risk of SAP in patients with ICH, the AUC (0.950, 95% CI 0.900 to 0.980) of the A2DS2 score was greater than the ICH-APS-A score and the ISAN score. When predicting risk of SAP in patients with AIS and ICH: 0.911 (95% CI 0.873 to 0.94) vs. 0.882 (95% CI 0.840 to 0.916), Z = 2.319, P = 0.020, the A2DS2 score was significantly better than the ISAN score ( P<0.05). When predicting risk of SAP in patients with AIS, the A2DS2 score, ISAN score, and AIS-APS score all have good predictive value ( P>0.05). When predicting SAP in patients with ICH, the A2DS2 score, ISAN score, and ICH-APS-A score all have good predictive value ( P>0.05). Conclusions:When predicting risk of SAP in patients, the A2DS2 score is a reliable prediction tool, with good predictive value.

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