卒中相关性肺炎：亚太地区视角

文献信息

中文摘要

背景： 卒中相关性肺炎（SAP）是急性缺血性卒中（AIS）的常见并发症，与死亡率、残疾、住院时间和医疗费用增加相关。全球SAP合并患病率估计为12.3%至14.3%，但亚太地区报告的发生率存在差异。鉴于仅中国在2021年就有410万例新发卒中病例，占全球卒中负担的三分之一，SAP在该地区构成了重大的临床和卫生系统挑战。
总结： 亚太地区各队列报告的SAP患病率差异很大，从日本的2.6%、新加坡的5.5%、中国国家卒中登记处的10.4%到泰国的15.8%不等，反映了诊断标准、病例构成、卒中严重程度和护理环境的差异。SAP常发生在卒中后早期；在一个日本队列中，77.3%的病例在72小时内发生。卒中严重程度是最一致报告的危险因素，此外还有吞咽困难、机械通气、高龄和合并症。证据支持涉及卒中诱导的免疫抑制和肠-脑-肺轴紊乱的多因素发病机制。大规模国际试验的普遍抗生素预防并未显示可减少SAP或改善功能结局。在亚太地区，预防性护理干预产生了不一致的结果；值得注意的是，一项中国评估者盲法随机对照试验的定制口腔护理报告显示，干预组SAP发生率为10.26%，而对照组为32.43%。总体而言，SAP定义、研究人群和干预设计的异质性限制了研究之间的直接比较。
关键信息： SAP是亚太地区AIS的常见并发症，尽管不同研究报告的患病率差异很大，且取决于所采用的诊断标准。卒中严重程度、吞咽困难、机械通气、高龄和合并症是经常报告的危险因素。预防性干预措施的证据仍然异质，凸显了在资源多样化的亚太地区制定标准化诊断标准以及进一步评估风险分层工具和多学科预防策略的必要性。

英文摘要

BACKGROUND: Stroke-associated pneumonia (SAP) is a frequent complication of acute ischemic stroke (AIS) and is associated with increased mortality, disability, length of hospital stay, and healthcare costs. Global pooled prevalence estimates of SAP range from 12.3% to 14.3%, but reported rates vary across the APAC region. Given that China alone accounted for 4.1 million incident stroke cases in 2021, representing one-third of the global stroke burden, SAP represents a substantial clinical and health-system challenge across the region.
SUMMARY: Reported SAP prevalence varied substantially across APAC cohorts, ranging from 2.6% in Japan, 5.5% in Singapore, 10.4% in the China National Stroke Registry and up to 15.8% in Thailand, reflecting differences in diagnostic criteria, case mix, stroke severity, and care settings. SAP frequently occurs early after stroke; in one Japanese cohort, 77.3% of cases developed within 72 hours. Stroke severity was the most consistently reported risk factor, alongside dysphagia, mechanical ventilation, older age, and comorbid disease. Evidence supports a multifactorial pathogenesis involving stroke-induced immunodepression and gut-brain-lung axis disruption. Large international trials of universal antibiotic prophylaxis have not demonstrated reductions in SAP or improvements in functional outcomes. In APAC, preventive care interventions have produced variable results; notably, a Chinese assessor-blinded randomized controlled trial of tailored oral health care reported SAP in 10.26% of the intervention group compared with 32.43% of controls. Overall, heterogeneity in SAP definitions, study populations, and intervention designs limits direct comparison between studies.
KEY MESSAGES: SAP is a common complication of AIS in the APAC region, although reported prevalence varies considerably between studies and according to diagnostic criteria applied. Stroke severity, dysphagia, mechanical ventilation, older age and comorbidities are frequently reported risk factors. Evidence for preventative interventions remains heterogenous, highlighting the need for standardised diagnostic criteria and further evaluation of risk-stratification tools and multidisciplinary prevention strategies in resource-diverse APAC settings.