重症机械通气患者血清可溶性髓系细胞触发受体-1、前肾上腺髓质素、黏连蛋白水平变化与呼吸机相关性肺炎关联性及预后预测价值

The relationship between serum sTREM-1,pro-ADM,Fn levels and VAP in patients with severe mechanical ventilation and prognostic value

目的探讨重症机械通气患者血清可溶性髓系细胞触发受体-1(sTREM-1)、前肾上腺髓质素(pro-ADM)、黏连蛋白(Fn)水平变化与呼吸机相关性肺炎(VAP)关联性及预后预测价值。方法选取本院2017年1月-2019年11月发生VAP的重症机械通气患者48例作为VAP组,未发生VAP者66例作为无VAP组。检测对比2组血清sTREM-1、pro-ADM、Fn水平,分析发生VAP的影响因素,对比不同预后患者各血清指标水平及临床肺部感染(CPIS)评分,分析血清各指标水平与CPIS评分关联性及对预后不良的预测价值。结果 VAP组血清sTREM-1、pro-ADM水平高于无VAP组,Fn水平低于无VAP组(P<0.05);机械通气时间、血清sTREM-1、pro-ADM、Fn水平与重症机械通气患者发生VAP密切相关(P<0.05);血清sTREM-1、pro-ADM与CPIS评分呈正相关,Fn与CPIS评分呈负相关(P<0.05);确诊VAP第3 d、第5 d血清sTREM-1、pro-ADM、Fn对预后不良均具有较高预测价值,其中确诊第5 d sTREM-1的AUC最大,为0.829;经KM生存曲线分析,血清sTREM-1、pro-ADM、Fn高危组、低危组生存曲线对比,差异有统计学意义(P<0.05)。结论血清sTREM-1、pro-ADM、Fn的异常表达是重症机械通气患者发生VAP的重要影响因素,且与患者CPIS评分密切相关,动态监测上述各血清指标,可为临床明确患者肺部感染病情及预测预后情况提供循证指导。

Objective To investigate the changes and prognostic value of serum soluble myeloid cell trigger receptor-1(sTREM-1),proadrenomedullin(pro-ADM)and fibronectin(Fn)levels in patients with severe mechanical ventilation and ventilator-associated pneumonia(VAP)relevance.Methods Forty eight patients with severe mechanical ventilation who developed VAP from January 2017 to November 2019 in our hospital were selected as the VAP group,and 66 patients who did not develop VAP were selected as the non-VAP group.The levels of serum sTREM-1,pro-ADM and Fn were compared between the two groups.The influencing factors of VAP were analyzed.The serum levels and clinical pulmonary infection(CPIS)scores of different prognosis patients were compared.The correlation between serum index levels and CPIS scores and their predictive value for poor prognosis was analyzed.Results The serum levels of sTREM-1 and pro-ADM in the VAP group were higher than those in the non-VAP group,and the Fn level was lower than that in the non-VAP group(P<0.05);mechanical ventilation time,serum sTREM-1,pro-ADM,Fn levels are closely related to the occurrence of VAP in severe mechanical ventilation patients(P<0.05);serum sTREM-1,pro-ADM were positively correlated with CPIS score,Fn was negatively correlated with CPIS score(P<0.05);serum sTREM-1,pro-ADM,and Fn on the 3 rd and 5 th days of confirmed VAP had high predictive value for poor prognosis,the AUC of sTREM-1 was the highest at the 5 th day of diagnosis,which was0.829;according to the analysis of KM survival curve,the difference in survival curves of serum sTREM-1,pro-ADM,Fn high-risk group and low-risk group was statistically significant(P<0.05).Conclusion The abnormal expression of serum sTREM-1,pro-ADM and Fn is an important influencing factor of VAP in patients with severe mechanical ventilation,and it is closely related to the patient’s CPIS score.Dynamic monitoring of these serum markers can be used to clinically identify patients with pulmonary infection and provide evidence-based guidance for predicting prognosis.