呼吸机相关肺炎患者病原菌分布及血清miR-101-3p、斯钙素1的检测分析

Distribution of pathogenic bacteria in patients with ventilator-associated pneumonia and detection of serum miR-101-3p and STC1

目的 探究呼吸机相关肺炎(ventilator-associated pneumonia,VAP)患者病原菌分布及血清微小RNA-101-3p(microRNA-101-3p,miR-101-3p)、斯钙素1(stanniocalcin 1,STC1)表达水平在VAP诊断中的临床意义。方法 选取2020年1月至2023年4月在安徽医科大学附属六安医院进行机械通气治疗,发生VAP的患者121例作为VAP组,未发生VAP的患者87例为非VAP组,同期健康体检者83例为对照组。采集VAP组患者下呼吸道分泌物进行病原菌鉴定;测定所有研究对象的血清STC1、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、miR-101-3p水平。采用Pearson法分析血清miR-101-3p、STC1与炎症因子PCT、CRP、TNF-α的相关性;采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析血清miR-101-3p、STC1对VAP的诊断价值。结果 121例VAP患者共检测分离出病原菌218株,其中革兰氏阴性菌124株(56.88%),革兰氏阳性菌86株(39.45%),真菌8株(3.67%);VAP组的血清miR-101-3p、PCT、CRP、TNF-α水平均显著高于非VAP组和对照组(P<0.05),STC1水平显著低于非VAP组和对照组(P<0.05);VAP患者的血清miR-101-3p水平与PCT、CRP、TNF-α呈正相关(P<0.05),STC1水平与PCT、CRP、TNF-α呈负相关(P<0.05);ROC曲线显示血清miR-101-3p、STC1单独及联合诊断VAP患者的曲线下面积(area under curve,AUC)分别为0.766、0.750、0.841,联合诊断价值高于二者单独诊断(Z二者联合-miR-101-3p=2.275、P=0.023,Z二者联合-STC1=2.856、P=0.004)。结论 VAP患者以革兰氏阴性菌感染为主,血清miR-101-3p呈高表达、STC1呈低表达,血清miR-101-3p、STC1联合诊断对于VAP的发生具有一定的诊断价值。

Objective To investigate the distribution of pathogenic bacteria in patients with ventilator-associated pneumonia (VAP) and the clinical significance of detecting the expression levels of serum microRNA-101-3p (miR-101-3p) and stanniocalcin 1 (STC1).Method From January 2020 to April 2023,121 patients who underwent mechanical ventilation treatment and developed VAP in our hospital were collected as the VAP group,87 patients who did not develop VAP were regarded as the non VAP group,and 83 healthy individuals were collected as the control group.Lower respiratory secretions were collected from patients in the VAP group for identification of pathogenic bacteria;Serum STC1,procalcitonin (PCT),C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),and serum miR-101-3p levels were measured in all study subjects.Pearson method was applied to analyze the correlation between serum miR-101-3p,STC1,and inflammatory factors PCT,CRP,and TNF-α;receiver operating characteristic curve (ROC curve) was applied to analyze the diagnostic value of serum miR-101-3p and STC1 for VAP.Result A total of 218 strains of pathogenic bacteria were detected and isolated from 121 VAP patients,of which 124 (56.88%) were Gram negative bacteria,86 strains (39.45%) were Gram positive bacteria,and 8 strains (3.67%) were fungi;the serum levels of miR-101-3p,PCT,CRP,and TNF-α in the VAP group were obviously higher than those in the non VAP group and control group (P< 0.05),while the level of STC1 was obviously lower than that in the non VAP group and control group (P<0.05);the serum miR-101-3p level in VAP patients were positively correlated with PCT,CRP,and TNF-α(P<0.05),while STC1 level were negatively correlated with PCT,CRP,and TNF-α (P<0.05);ROC curve showed that the area under the curve (AUC) of serum miR-101-3p and STC1 alone and in combination for diagnosis of VAP patients were 0.766,0.750,and 0.841,respectively,the combined diagnostic value was higher than that of the two alone (Z combination-miR-101-3p=2.275,P=0.023,Z combination-STC1=2.856,P=0.004).Conclusion The patients with VAP were predominantly infected with Gram negative bacteria,and the serum miR-101-3p is highly expressed,while STC1 is low expressed.The combination of serum miR-101-3p and STC1 has certain diagnostic value for the occurrence of VAP.