老年脑卒中后吞咽障碍患者继发吸入性肺炎危险因素及预测模型的建立

卢素娟; 林敏; 宋利; 陈菲菲; 陈秀芳

doi:10.16766/j.cnki.issn.1674-4152.004001

老年脑卒中后吞咽障碍患者继发吸入性肺炎危险因素及预测模型的建立

doi: 10.16766/j.cnki.issn.1674-4152.004001

温州医科大学附属第一医院老年医学科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2024KY1246

详细信息

通讯作者:
陈秀芳，E-mail: 13858881807@139.com

中图分类号: R743 R563.1
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- 文章访问数: 10
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出版历程
- 收稿日期: 2024-10-09
- 网络出版日期: 2025-08-14

Establishment of a risk prediction model for secondary aspiration pneumonia in elderly stroke patients with dysphagia

Department of Geriatrics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的分析脑卒中后吞咽障碍(PSD)患者继发吸入性肺炎(AP)的相关危险因素，并建立预测模型，以期为临床预防PSD患者AP的发生和干预提供科学依据。方法回顾性收集2022年2月—2024年2月温州医科大学附属第一医院收治的82例老年PSD患者的临床资料，根据老年PSD患者是否继发AP分为AP组和Non-AP组，进行单因素、多因素logistic分析研究PSD继发AP的危险因素，并建立预测模型，通过受试者工作特征(ROC)曲线分析模型的预测效能。结果 82例PSD患者发生AP 31例，发生率为37.80%，纳入AP组，未发生AP的51例患者纳入Non-AP组。单因素分析结果显示，AP组和Non-AP组年龄、吸烟史、美国国立卫生研究院脑卒中量表(NIHSS)评分、洼田饮水试验、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、住院时间、管饲差异均有统计学意义(P＜0.05)。多因素logistic回归分析显示，年龄、NIHSS评分、洼田饮水试验是PSD患者继发AP的独立影响因素(P＜0.05)。ROC曲线分析显示该模型预测PSD患者发生AP的AUC为0.845(95% CI：0.659~0.953)，以0.39为模型cut-off，其诊断PSD患者继发AP的灵敏度、特异度分别为88.89%、68.42%。结论高龄、高NIHSS评分、高洼田饮水试验级别为PSD患者继发AP的独立危险因素，根据危险因素构建的预测模型对PSD患者继发AP有一定的预测价值。
- 脑卒中 /
- 老年 /
- 吞咽障碍 /
- 吸入性肺炎 /
- 危险因素 /
- 预测模型
Abstract: Objective To analyze the risk factors of secondary aspiration pneumonia (AP) in patients with post-stroke dysphagia (PSD) and to establish a prediction model, aiming to provide a scientific basis for clinical prevention and intervention strategies. Methods Clinical data of elderly patients with PSD admitted to the First Affiliated Hospital of Wenzhou Medical University from February 2022 to February 2024 were retrospectively collected. The elderly patients with PSD were divided into an AP group and a non-AP group according to the presence or absence of secondary AP. The risk factors of secondary AP in PSD were analyzed by univariate and multivariate logistic analyses, and a prediction model was subsequently established. The predictive efficiency of the model was evaluated by receiver operating characteristic (ROC) curve analysis. Results Among the 82 patients with PSD, 31 developed AP, yielding an incidence rate of 37.80%. Univariate analysis showed statistically significant differences between the AP and non-AP group in age, smoking history, the National Institutes of Health stroke scale (NIHSS) score, Water swallow test results, high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), length of hospital stay, and tube feeding. Multivariate logistic regression analysis results identified age, NIHSS score, and water swallow test results as independent influence factors for secondary AP in patients with PSD (P < 0.05). Based on the logistic analysis results, a prediction model was constructed. ROC curve analysis showed that the AUC of this model was 0.845 (95% CI: 0.659-0.953). At a cut-off value of 0.39, the model achieved a sensitivity of 88.89% and specificity of 68.42%. Conclusion Advanced age, elevated NIHSS score, and high drinking water test level were independent risk factors for secondary AP in PSD patients. The prediction model based on these risk factors demonstrates good discriminative ability for predicting secondary AP in PSD patients.
- Stroke /
- Elderly /
- Dysphagia /
- Inhalation pneumonia /
- Risk factor /
- Prediction model

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图 1 各指标单独及联合预测PSD患者继发AP的ROC曲线

Figure 1. ROC curve of secondary AP in PSD patients

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表 1 2组PSD患者一般资料比较

Table 1. Comparison of clinical data of 2 groups of PSD patients

组别	例数	性别[例(%)]		年龄(x±s，岁)	既往疾病史[例(%)]					吸烟史[例(%)]	饮酒史[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	高血压	糖尿病	心房颤动	冠心病	慢性阻塞性肺疾病	吸烟史[例(%)]	饮酒史[例(%)]
AP组	31	16(51.61)	15(48.39)	77.42±3.68	28(90.32)	16(51.61)	6(19.35)	15(48.39)	10(32.26)	18(58.06)	10(32.26)
Non-AP组	51	29(56.86)	22(43.14)	71.87±3.75	42(82.35)	25(49.02)	3(5.88)	18(35.29)	14(27.45)	15(29.41)	12(23.53)
统计量		0.215^a		6.544^b	0.980^a	0.052^a	3.582^a	1.374^a	0.215^a	6.582^a	0.748^a
P值		0.643		< 0.001	0.322	0.820	0.058	0.241	0.643	0.010	0.387
注：^a为χ²值，^b为t值。

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表 2 2组PSD患者疾病相关资料比较

Table 2. Comparison of disease-related characteristics between two groups of PSD patients

组别	例数	病程(x±s，d)	卒中类型[例(%)]		NIHSS评分(x±s，分)	偏瘫侧[例(%)]			卒中部位[例(%)]		构音障碍[例(%)]
组别	例数	病程(x±s，d)	缺血性	出血性	NIHSS评分(x±s，分)	单侧	双侧		脑干区	非脑干区	构音障碍[例(%)]
AP组	31	40.32±5.24	27(87.10)	4(12.90)	9.84±1.78	25(80.65)	6(19.35)		6(19.35)	25(80.65)	24(77.42)
Non-AP组	51	38.48±4.59	45(88.24)	6(11.76)	8.13±1.69	45(88.24)	6(11.76)		9(17.65)	42(82.35)	34(66.67)
统计量		1.668^a	0.023^b		6.901^a	0.889^b			0.038^b		1.077^b
P值		0.099	0.879		< 0.001	0.346			0.846		0.299

组别	例数	洼田饮水试验[例(%)]			低蛋白血症[例(%)]	WBC(×10⁹/L)		PLT(×10⁹/L)		hs-CRP(mg/L)	PCT(ng/mL)
组别	例数	3~4级	5级		低蛋白血症[例(%)]	WBC(×10⁹/L)		PLT(×10⁹/L)		hs-CRP(mg/L)	PCT(ng/mL)
AP组	31	19(61.29)	12(38.71)		16(51.61)	6.85±1.37		221.72±65.23		36.25±4.13	1.04±0.15
Non-AP组	51	49(96.08)	2(3.92)		17(33.33)	6.57±1.24		205.46±59.73		28.39±5.51	0.93±0.11
统计量		16.481^b			2.679^b	0.953^a		1.154^a		4.237^a	3.818^a
P值		< 0.001			0.102	0.344		0.252		< 0.001	< 0.001
注：^a为t值，^b为χ²值。

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表 3 2组PSD患者治疗相关资料比较

Table 3. Comparison of treatment-related data of two groups of PSD patients

组别	例数	药物使用史[例(%)]				住院时间(x±s，d)	气管切开[例(%)]	管饲[例(%)]	白天常用卧位[例(%)]
组别	例数	抗生素	糖皮质激素	抑酸剂	脱水剂	住院时间(x±s，d)	气管切开[例(%)]	管饲[例(%)]	侧卧位	仰卧位	俯卧位
AP组	31	5(16.13)	3(9.68)	9(29.03)	13(41.94)	14.64±2.58	7(22.58)	15(48.39)	6(19.35)	14(45.16)	11(35.48)
Non-AP组	51	5(9.80)	4(7.84)	11(21.57)	22(43.14)	12.86±2.37	6(11.76)	12(23.53)	21(41.18)	22(43.14)	8(15.68)
统计量		0.720^a	0.083^a	0.582^a	0.011^a	3.189^b	1.691^a	5.394^a	5.220^a
P值		0.396	0.773	0.445	0.915	0.002	0.194	0.020	0.074
注：^a为χ²值，^b为t值。

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表 4 变量赋值情况

Table 4. Variable assignment

变量	赋值方法
年龄	连续性变量，以实际值赋值
吸烟史	是=1，否=0
NIHSS评分	连续性变量，以实际值赋值
洼田饮水试验	5级=1，3~4级=0
hs-CRP	连续性变量，以实际值赋值
PCT	连续性变量，以实际值赋值
住院天数	连续性变量，以实际值赋值
管饲	是=1，否=0

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表 5 PSD患者继发AP多因素logistic分析

Table 5. Multivariate logistic analysis of secondary AP in PSD patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.106	0.045	5.512	0.019	1.111	1.018~1.214
吸烟史	0.223	0.134	2.769	0.097	1.250	0.961~1.625
NIHSS评分	0.100	0.029	11.833	0.001	1.105	1.044~1.170
洼田饮水试验	0.094	0.032	8.544	0.004	1.098	1.031~1.169
hs-CRP	0.121	0.087	1.936	0.165	1.129	0.952~1.339
PCT	0.611	0.351	3.027	0.083	1.842	0.926~3.664
住院天数	0.023	0.014	2.708	0.101	1.023	0.996~1.052
管饲	0.062	0.042	2.187	0.140	1.064	0.980~1.155

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表 6 PSD患者继发AP预测价值分析

Table 6. Analysis of predictive value of secondary AP in PSD patients

项目	cut-off	约登指数	AUC	95% CI	灵敏度(%)	特异度(%)	P值
年龄	75.94岁	0.345	0.673	0.470~0.837	55.56	78.95	0.038
NIHSS评分	9.63分	0.409	0.708	0.506~0.863	77.78	69.16	0.026
洼田饮水试验		0.456	0.728	0.528~0.878	66.67	78.95	0.017
模型	0.39	0.573	0.845	0.659~0.953	88.89	68.42	＜0.001

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