切换至 "中华医学电子期刊资源库"
高级检索
中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 263 -269. doi: 10.3877/cma.j.issn.1674-1358.2021.04.008

论著

超敏C-反应蛋白和中性粒细胞/淋巴细胞比值对急性缺血性脑卒中相关感染的诊断、预后预测价值及影响
叶舟1, 王从平1,†()   
  1. 1. 445000　恩施土家族苗族自治州，恩施土家族苗族自治州中心医院神经内科
  • 收稿日期:2020-09-07 出版日期:2021-08-15
  • 通信作者: 王从平

Value and influence of high sensitivity C-reactive protein and neutrophil/lymphocyte ratio on diagnosis and prognosis of acute ischemic stroke related infection

Zhou Ye1, Congping Wang1,†()   

  1. 1. Department of Neurology, The Central Hospital of Enshi Autonomous Prefecture, Enshi Autonomous Prefecture 445000, China
  • Received:2020-09-07 Published:2021-08-15
  • Corresponding author: Congping Wang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

叶舟, 王从平. 超敏C-反应蛋白和中性粒细胞/淋巴细胞比值对急性缺血性脑卒中相关感染的诊断、预后预测价值及影响[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(04): 263-269.

Zhou Ye, Congping Wang. Value and influence of high sensitivity C-reactive protein and neutrophil/lymphocyte ratio on diagnosis and prognosis of acute ischemic stroke related infection[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(04): 263-269.

目的

分析超敏C-反应蛋白和中性粒细胞/淋巴细胞比值在急性缺血性脑卒中（AIS）相关感染中的诊断及预后预测价值。

方法

回顾性分析2017年1月至2019年6月恩施土家族苗族自治州中心医院收治的120例AIS患者临床资料以及随访资料，根据患者发病1周内是否发生感染（以肺部感染和泌尿道感染为主）分为感染组（34例）和未感染组（86例）；比较感染组和未感染组患者血浆hs-CRP和NLR变化，并绘制受试工作者曲线（ROC）探讨hs-CRP和NLR在AIS相关感染中的诊断价值（曲线下面积）；采用Logistic回归分析hs-CRP和NLR对AIS相关感染的影响。根据改良Rankin量表（mRS）将34例感染者分为预后良好组（10例，mRS≤ 2）和预后不良组（24例、mRS> 2），比较预后良好组和预后不良组患者血浆hs-CRP和NLR水平，绘制ROC探讨hs-CRP和NLR在AIS相关感染预后中的预测价值（曲线下面积）；采用Cox回归分析探讨hs-CRP和NLR对AIS相关感染不良预后的影响。

结果

感染组和未感染组患者入组第2天血浆hs-CRP[（7.28 ± 2.35） vs. （7.16 ± 2.11）mg/L]和NLR（4.06 ± 0.91 vs. （3.81 ± 0.85）差异无统计学意义（t = 0.272、P = 0.786，t = 1.423、P = 0.157）；但在第5天和第7天感染组患者血浆hs-CRP[（15.63 ± 3.88）mg/L和（24.37 ± 4.95）mg/L]和NLR[（6.22 ± 1.73）和（7.82 ± 2.64）]显著高于未感染组[hs-CRP：（7.89 ± 2.42）mg/L和（8.45 ± 2.61）mg/L；NLR：（4.16 ± 0.92）和（4.43 ± 1.07），差异均有统计学意义（hs-CRP：t = 13.160、P < 0.001，t = 22.916、P < 0.001；NLR：t = 8.454、P < 0.001，t = 10.047、P < 0.001）。感染组患者入组第2天、第5天、第7天hs-CRP（F = 165.200、P < 0.001）和NLR水平（F = 33.660、P < 0.001）差异均有统计学意义；未感染组患者入组第2天、第5天、第7天hs-CRP（F = 6.306、P = 0.002）和NLR水平（F = 9.187、P < 0.001）差异均有统计学意义。ROC曲线分析显示，hs-CRP和NLR均可作为诊断AIS相关感染的指标[hs-CRP：曲线下面积（AUC）：0.634、95%CI：0.593~0.688；NLR：AUC：0.685，95%CI：0.641~0.734]，但两者联合诊断价值更高（AUChs-CRP+NLR vs. AUChs-CRP：Z = 9.645、P < 0.001，AUChs-CRP+NLR vs. AUCNLR：Z = 8.211、P < 0.001，AUChs-CRP vs. AUCNLR：Z = 1.536、P = 0.629），敏感度（64.2%和63.8%）和特异度（60.7%和65.1%）提高至85.7%和81.4%。Logistic回归分析显示，入院第2天hs-CRP每升高5 mg/L和NLR每升高2.00，AIS相关感染发生风险增加1.295倍和1.903倍（P = 0.027、P = 0.001）。预后良好组和预后不良组患者血浆hs-CRP分别为（22.45 ± 3.15）mg/L和（26.23 ± 4.47）mg/L，NLR分别为（6.51 ± 1.74）和（8.39 ± 2.05），差异有统计学意义（t = 2.425、P = 0.021，t = 2.538、P = 0.016）。ROC曲线分析显示，入院第7天hs-CRP和NLR均可预测AIS相关感染的预后（hs-CRP：AUC：0.572、95%CI：0.544~0.621；NLR：AUC：0.641、95%CI：0.612~0.684），但两者联合诊断价值更高（AUChs-CRP+NLR vs. AUChs-CRP：Z = 9.645、P < 0.001，AUChs-CRP+NLR vs. AUCNLR：Z = 8.211、P < 0.001），敏感度（65.4%和60.2%）和特异度（64.9%和67.4%）提高至84.3%和80.1%。Cox回归分析显示，入院第7天hs-CRP每升高2 mg/L和NLR每升高1.50，AIS相关感染预后不良的风险分别增加1.423倍和1.784倍（P = 0.022、P = 0.009）。

结论

hs-CRP和NLR在诊断AIS相关感染及预测预后方面具有一定价值，其水平升高在一定程度上可增加AIS相关感染和预后不良发生的风险。

关键词: 急性缺血性脑卒中, 感染, 超敏C-反应蛋白, 中性粒细胞/淋巴细胞比值, 预后, 影响因素
Objective

To investigate the value and influence of high sensitivity C-reactive protein (hs-CRP) and neutrophil/lymphocyte ratio (NLR) on diagnosis and prognosis of acute ischemic stroke (AIS) related infection.

Methods

The clinical data (including follow-up) of 120 patients with AIS diagnosed and treated in the Central Hospital of Enshi Autonomous Prefecture from January 2017 to June 2019 were analyzed, retrospectively, the 120 patients were divided into infection group (34 cases) and non-infection group (86 cases) based on whether had infection within one week of onset (lung infection and urinary tract infection were dominated). The changes of plasma hs-CRP and NLR between infection group and non-infection group were compared, and the diagnostic value of hs-CRP and NLR in AIS-related infections were analyzed by receiver operator characteristic curve (ROC). The effects of hs-CRP and NLR on AIS-related infections were analyzed by Logistic regression analysis. According to the modified Rankin Scale (mRS), 34 patients with infection were divided into good prognosis group (10 cases, mRS ≤ 2) and poor prognosis group (24 cases, mRS > 2). The differences between CRP and NLR were plotted as ROC to explore the predictive value in the prognosis of AIS-related infections. The impact of hs-CRP and NLR on the poor prognosis of AIS-related infections were analyzed by Cox regression analysis.

Results

There was no significant difference in plasma hs-CRP [(7.28 ± 2.35) mg/L vs. (7.16 ± 2.11) mg/L] and NLR [ (4.06 ± 0.91) vs. (3.81 ± 0.85)] between patients of infection group and non-infection group on the second day after enrolled (t = 0.272, P = 0.786; t = 1.423, P = 0.157), but on the fifth day and the seventh day, the plasma hs-CRP [ (15.63 ± 3.88) mg/L and (24.37 ± 4.95) mg/L] and NLR[ (6.22 ± 1.73) and (7.82 ± 2.64)] of patients in infection group were significantly higher than those of non-infection group [hs-CRP: (7.89 ± 2.42) mg/L and (8.45 ± 2.61) mg/L, NLR: (4.16 ± 0.92) and (4.43±1.07)], with significant differences (hs-CRP: t = 13.160, P < 0.001, t = 22.916, P < 0.001; NLR: t = 8.454, P < 0.001; t = 10.047, P < 0.001). The levels of hs-CRP (F = 165.200, P < 0.001) and NLR (F = 33.660, P < 0.001) of patients in infection group on the second, fifth and seventh day after enrolled were significantly different. The levels of hs-CRP (F = 6.306, P = 0.002) and NLR (F = 9.187, P < 0.001) of patients in non-infection group on the second, fifth and seventh day after enrolled were significantly different. ROC analysis showed that both hs-CRP (AUC: 0.634, 95%CI: 0.593-0.688) and NLR on the 2nd day of admission could diagnose AIS-related infections (AUC: 0.685, 95%CI: 0.641-0.734), but the value of the two indexes combination was higher (AUChs-CRP+NLR vs. AUChs-CRP: Z = 9.645, P < 0.001; AUChs-CRP+NLR vs. AUCNLR: Z = 8.211, P < 0.001; AUChs-CRP vs. AUCNLR: Z = 1.536, P = 0.629), while the sensitivity (64.2% and 63.8%) and specificity (60.7% and 65.1%) increased to 85.7% and 81.4%, respectively. According to Logistic regression analysis, for every 5 mg/L increase of hsCRP and 2.00 increase of NLR on the 2nd day of admission, the risk of AIS related infection increased 1.295 and 1.903 times (P = 0.027, P = 0.001). The plasma hs-CRP of patients in good prognosis group and poor prognosis group were (22.45 ± 3.15) mg/L and (26.23 ± 4.47) mg/L, respectively (t = 2.425, P = 0.021); NLR were (6.51 ± 1.74) and (8.39 ± 2.05), respectively (t = 2.538, P = 0.016), with significant differences. ROC analysis showed that both hs-CRP (AUC: 0.572, 95%CI: 0.544-0.621) and NLR (AUC: 0.641, 95%CI: 0.612-0.684) on the 7th day of admission could predict the prognosis of AIS-related infections, but the value of the two indexes combination was higher (AUChs-CRP+NLR vs. AUChs-CRP: Z = 9.645, P < 0.001; AUChs-CRP+NLR vs. AUCNLR: Z = 8.211, P < 0.001), the sensitivity (65.4% and 60.2%) and specificity (64.9% and 67.4%) increased to 84.3% and 80.1%, respectively. Cox regression analysis showed that for every 2 mg/L increase of hs-CRP and 1.50 increase of NLR on the 7th day, the risk of poor prognosis of AIS related infection increased by 1.423 and 1.784 times, respectively (P = 0.022, P = 0.009).

Conclusions

hs-CRP and NLR had a certain value in the diagnosis of AIS related infection and prediction of prognosis. To a certain extent, the increase of the above indicators could increase the risk of AIS related infection and poor prognosis, which had a certain clinical value.

Key words: Acute ischemic stroke, Infection, High-sensitivity C-reactive protein, Neutrophil/lymphocyte ratio, Prognosis, Influencing factor
表1 感染组和未感染组AIS患者的基线资料
组别 例数 性别（例，男/女） 平均年龄（± s，岁）
感染组 34 20/14 55.39 ± 10.54
未感染组 86 45/41 56.17 ± 11.08
统计量   χ2 = 0.414 t = 0.352
P值   0.519 0.725
表2 感染组和未感染组AIS患者发病1周内血浆hs-CRP和NLR水平（± s）
组别 例数 hs-CRP（mg/L） NLR
第2天 第5天 第7天 F值 P值 第2天 第5天 第7天 F值 P值
感染组 34 7.28 ± 2.35 15.63 ± 3.88 24.37 ± 4.95 165.200 < 0.001 4.06 ± 0.91 6.22 ± 1.73 7.82 ± 2.64 33.660 < 0.001
未感染组 86 7.16 ± 2.11 7.89 ± 2.42 8.45 ± 2.61 6.306 0.002 3.81 ± 0.85 4.16 ± 0.92 4.43 ± 1.07 9.187 < 0.001
t值   0.272 13.160 22.916     1.423 8.454 10.047    
P值   0.786 < 0.001 < 0.001     0.157 < 0.001 < 0.001    
图1 hs-CRP和NLR诊断AIS相关感染的ROC图
表3 hs-CRP和NLR在AIS相关感染中的诊断价值
指标 AUC 95%CI值 P值 截断值 敏感度（%） 特异度（%）
hs-CRP（mg/L） 0.634 0.593~0.688 0.017 9.85 64.2 60.7
NLR 0.685 0.641~0.734 0.011 5.03 63.8 65.1
hs-CRP + NLR 0.864 0.811~0.923 0.001 — 85.7 81.4
表4 hs-CRP和NLR影响AIS相关感染的Logistic回归分析
指标 β值 SE值 Wald χ2 P值 OR值 95%CI值
入院第2天hs-CRP（每升高5 mg/L） 1.032 0.484 4.546 0.027 1.295 1.032~1.638
入院第2天NLR（每升高2.00） 1.251 0.509 6.041 0.001 1.903 1.625~2.475
表5 预后良好和预后不良AIS感染者的一般资料
组别 例数 性别（男/女） 平均年龄（± s，岁） 入院第7天hs-CRP（± s ，mg/L） 入院第7天NLR（± s）
预后良好者 10 6/4 56.65 ± 11.13 22.45 ± 3.15 6.51 ± 1.74
预后不良者 24 11/13 57.91 ± 10.58 26.23 ± 4.47 8.39 ± 2.05
统计量   χ2 = 0.567 t = 0.310 t = 2.425 t = 2.538
P值   0.452 0.760 0.021 0.016
图2 hs-CRP和NLR预测AIS相关感染预后的ROC图
表6 hs-CRP和NLR在AIS相关感染预后中的预测价值
指标 AUC 95%CI值 P值 截断值 敏感度（%） 特异度（%）
hs-CRP（mg/L） 0.572 0.544~0.621 0.034 23.17 65.4 60.2
NLR 0.641 0.612~0.684 0.025 7.06 64.9 67.4
hs-CRP + NLR 0.817 0.785~0.853 0.004 — 84.3 80.1
表7 hs-CRP和NLR影响AIS相关感染预后的Cox回归分析
指标 β值 SE值 Wald χ2 P值 HR值 95%CI值
入院第7天hs-CRP（每升高2 mg/L） 0.934 0.449 4.327 0.022 1.423 1.045~1.739
入院第7天NLR（每升高1.50） 1.045 0.457 5.229 0.009 1.784 1.315~2.325
[1]
中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682.
[2]
丁琪，陈旭. 急性缺血性脑卒中预后影响因素研究[J]. 中华老年心脑血管病杂志,2016,18(11):1182-1185.
[3]
Suda S, Aoki J, Shimoyama T, et al. Stroke-associated infection independently predicts 3-month poor functional outcome and mortality[J]. J Neurol,2018,265(2):370-375.
[4]
Mengel A, Ulm L, Hotter B, et al. Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke-the PREDICT study[J]. BMC Neurol,2019,19(1):148-154.
[5]
安媛，周大伟，石广志. 缺血性脑卒中并机械通气患者发生呼吸机相关性肺炎危险因素及预后分析[J]. 中华实验和临床感染病杂志(电子版),2021,15(3):164-170.
[6]
夏莹，王颖，何怀武，等. 白细胞,降钙素原和超敏C反应蛋白在超高龄重症患者血流感染的诊断预测价值[J]. 中华医学杂志,2019,99(5):365-369.
[7]
董莹，王增武，王馨，等. 中国中年人群超敏C反应蛋白与心血管事件,总死亡事件的关联研究[J]. 中华流行病学杂志,2018,39(4):428-432.
[8]
Forget P, Khalifa C, Defour JP, et al. What is the normal value of the neutrophil-to-lymphocyte ratio?[J]. BMC Res Notes,2017,10(1):12- 18.
[9]
Faria SS, Fernandes PC Jr, Silva MJ, et al. The neutrophil-to-lymphocyte ratio: a narrative review[J]. Ecancermedicalscience, 2016,19(10):702-715.
[10]
翟萌萌，王建平，余列，等. 中性粒细胞与淋巴细胞比值对急性脑梗死患者预后的预测价值[J]. 中国脑血管病杂志,2017,14(2):82-86.
[11]
陆敏智，黄鹏，仲玲玲，等. 缺血性脑卒中患者近期功能预后影响因素分析[J]. 中华物理医学与康复杂志,2018,40(1):38-40.
[12]
中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志,2015,48(4):246-257.
[13]
Quinn TJ, Dawson J, Walters MR, et al. Reliability of the modified Rankin Scale: a systematic review[J]. Stroke,2009,40(10):3393-3395.
[14]
Kamel H, Healey JS. Cardioembolic Stroke. Circ Res[J]. 2017,120(3):514-526.
[15]
Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome[J]. Acta Neurol Scand,2018,138(4):293-300.
[16]
Mengel A, Ulm L, Hotter B, et al. Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke--the PREDICT study[J].BMC Neurol,2019,19(1):148-153.
[17]
夏尤佳，沈朝斌，周云芳，等. C-反应蛋白在炎症反应中的免疫作用机制研究进展[J]. 国际儿科学杂志,2008,35(3):237-239.
[18]
Deme D, Telekes A. A C-reaktív protein (CRP) plazmaszintjének prognosztikai jelentősége az onkológiában [Prognostic importance of plasma C-reactive protein (CRP) in oncology[J]. Orv Hetil,2017,158(7):243-256.
[19]
徐留玉. 中国人群基线血清C-反应蛋白(CRP)对远处转移性前列腺癌患者预后的价值及相关性研究[D]. 山东大学,2017.
[20]
马亚平，吕辉. CRP和高敏CRP联合血常规检测在儿科疾病诊断中的应用[J]. 国际检验医学杂志,2011,32(9):1004-1005.
[21]
Li S, Pan G, Chen H, et al. Determination of derum homocysteine and hypersensitive C-reactive protein and their correlation with premature coronary heart disease[J]. Heart Surg Forum,2019,22(3):215-217.
[22]
韩媛，王爽，黄超，等. 急性缺血性脑卒中患者血清Lp-PLA2与HCY, hsCRP及生化指标的相关性分析[J]. 中华急诊医学杂志,2019,28(8):1026-1028.
[23]
丁新苑，童宣霞，方传勤. 中性粒细胞/淋巴细胞比值预测卒中相关性肺炎[J]. 国际脑血管病杂志,2017,25(11):979-983.
[24]
刘乐乐，李华. 中性粒细胞和淋巴细胞VCS参数与NLR对肿瘤患者化疗后细菌感染辅助诊断价值[J]. 中华肿瘤防治杂志,2019,26(3):190-193.
[25]
朱锋，季燕. 中性粒细胞与淋巴细胞比率与急性缺血性卒中预后的关系[J]. 南通大学学报(医学版),2019,39(2):146-148.
[1] 农云洁, 黄小桂, 黄裕兰, 农恒荣. 超声在多重肺部感染诊断中的临床应用价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(09): 872-876.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[4] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[5] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[6] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[7] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[8] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[9] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[10] 王贝贝, 崔振义, 王静, 王晗妍, 吕红芝, 李秀婷. 老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 355-362.
[11] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[12] 陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[13] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[14] 贾玲玲, 滕飞, 常键, 黄福, 刘剑萍. 心肺康复在各种疾病中应用的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 859-862.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号