高迁移率族蛋白B1对呼吸机相关性肺炎患者短期内撤机的预测价值

HMGB1 as an indicator for short-term weaning from mechanical ventilation in patients with ventilator-associated pneumonia

目的探讨高迁移率族蛋白B1(HMGB1)对呼吸机相关性肺炎(VAP)患者短期内撤机的预测价值。方法选取绍兴市人民医院2016年1月至2018年12月行机械通气且发生VAP的62例患者为研究对象,根据临床VAP的发生时间分成VAP早发组32例和晚发组30例。比较两组患者机械通气时间、ICU住院时间及确诊VAP当天急性生理和慢性健康评分Ⅱ(APACHEⅡ)、临床肺部感染评分(CPIS)、氧合指数(PaO2/FiO2),支气管肺泡灌洗液(BALF)中细胞因子(TNF-α、IL-8、HMGB1)水平,肺泡巨噬细胞吞噬活性及HMGB1蛋白相对表达量,同时评估上述指标对7 d机械通气撤机拔管的预测效能。结果VAP晚发组机械通气时间、ICU住院时间明显短于早发组(均P<0.05),确诊VAP当天APACHEⅡ、CPIS、PaO2/FiO2两组比较差异均无统计学意义(均P>0.05)。早发组确诊VAP时BALF中TNF-α、IL-8、HMGB1水平明显高于晚发组(均P<0.05)。晚发组肺泡巨噬细胞吞噬活性强于早发组,巨噬细胞中HMGB1蛋白相对表达量低于早发组,差异均有统计学意义(均P<0.05)。62例患者7 d机械通气撤机拔管率为71.0%。BALF中HMGB1水平预测7 d机械通气撤机拔管的AUC、截断值、灵敏度、特异度为0.75、50.0μg/L、0.78、0.70,肺泡巨噬细胞吞噬活性预测7 d机械通气撤机拔管的AUC、截断值、灵敏度、特异度为0.79、6.5、0.73、0.70,巨噬细胞HMGB1蛋白相对表达量预测7 d机械通气撤机拔管的AUC、截断值、灵敏度、特异度为0.73、1.4、0.72、0.73。结论HMGB1和肺泡巨噬细胞吞噬活性可作为预测VAP患者短期内撤机的可靠指标。

Objective To explore the prediction value of high mobility group box 1(HMGB1)for weaning of mechanical ventilation in patients with ventilator-associated pneumonia(VAP).Methods A total of 62 VAP patients admitted in the ICU of Shaoxing People’s Hospital from Jannuary 2016 to December 2018 were enrolled in the study,including 32 cases of early VAP and 30 cases of late VAP.The demographics and clinical data were collected,while acute physiology and chronic health evaluationⅡ(APACHEⅡ),clinical pulmonary infection score(CPIS)and oxygenation index(PaO2/FiO2)were assessed on the day of VAP diagnosis.Bronchoalveolar lavage was performed and the concentrations of TNF-α,IL-8 and HMGB1 in bronchoalveolar lavage fluid(BALF)were measured.Phagocytic activity of alveolar macrophages and the relative protein content of HMGB1 were detected.Prediction effect of above indexes on 7-day weaning from mechanical ventilation was evaluated.Results There were no significant differences in APACHEⅡ,CPIS,oxygenation index on the day of VAP diagnosis between two groups(P>0.05).However,the mechanical ventilation time and length of ICU stay in late VAP group were significantly shorter than those in early VAP group(all P<0.05).The levels of TNF-α,IL-8 and HMGB1 in BALF were significantly higher in early VAP group than those in late VAP group(P<0.05).The HMGB1 protein content in macrophages in early VAP group was higher than that in late VAP group,while the phagocytosis activity of macrophages in early VAP group was significantly lower than that in late VAP group(all P<0.05).The 7-day weaning rate of mechanical ventilation was 71.0%in 62 patients.The AUC,cutoff value,sensitivity and specificity of HMGB1 level in BALF to predict 7-day weaning rate were 0.75,50.0μg/L,0.78,0.70 respectively.The AUC,cutoff value,sensitivity and specificity of phagocytosis activity of macrophages to predict 7-day weaning rate were 0.79,6.5,0.73 and 0.70,respectively.The AUC,cutoff value,sensitivity and specificity of HMGB1 protein content in macrophages to predict 7-day weaning rate were 0.73,1.4,0.72 and 0.73,respectively.Conclusion The HMGB1 in BALF and phagocytosis activity of alveolar macrophage can be used as predicting indicators in patients with VAP.