外周血TLR2、TIPE2、NLR联合检测对机械通气新生儿呼吸机相关性肺炎的预测价值

Value of combined detection of TLR2,TIPE2 and NLR in peripheral blood for the prediction of ventilator-associated pneumonia in neonates with mechanical ventilation

目的探讨外周血Toll样受体2(TLR2)、肿瘤坏死因子α诱导蛋白8样因子2(TIPE2)、中性粒细胞与淋巴细胞比值(NLR)联合检测对机械通气新生儿呼吸机相关性肺炎(VAP)的预测价值。方法选取2020年6月至2023年6月河北北方学院附属第一医院进行机械通气治疗的232例新生儿作为研究对象。将发生VAP的新生儿纳入VAP组,其余纳入非VAP组。检测并比较两组外周血TLR2、TIPE2表达水平和NLR。绘制受试者工作特征(ROC)曲线评估外周血TLR2、TIPE2、NLR单独及联合预测机械通气新生儿VAP发生的价值。采用多因素Logistic回归分析机械通气新生儿发生VAP的影响因素。结果232例机械通气新生儿中,60例发生VAP,发生率为25.86%,纳入VAP组;其余172例未发生VAP,纳入非VAP组。VAP组和非VAP组机械通气时间、置管次数和吸痰次数比较,差异均有统计学意义(P<0.05)。VAP组TLR2相对表达水平和NLR高于非VAP组,TIPE2相对表达水平低于非VAP组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,机械通气时间≥3 d、置管次数≥2次、吸痰次数≥5次/天、TLR2相对表达水平升高、NLR升高是械通气新生儿发生VAP的危险因素(P<0.05),TIPE2相对表达水平升高是新生儿发生VAP的保护因素(P<0.05)。ROC曲线分析结果显示,TLR2、TIPE2和NLR单独预测机械通气新生儿发生VAP的曲线下面积(AUC)分别为0.783、0.754、0.745;且外周血TLR2、TIPE2、NLR联合检测预测机械通气新生儿发生VAP的AUC为0.823。结论外周血TLR2、TIPE2和NLR均是机械通气新生儿发生VAP的独立影响因素,且联合检测有助于预测VAP的发生。

Objective To investigate the predictive value of combined detection of toll-like receptor 2(TLR2),tumor necrosis factorα-induced protein 8-like 2(TIPE2)and neutrophil to lymphocyte ratio(NLR)in peripheral blood for ventilator-associated pneumonia(VAP)in neonates with mechanical ventilation.Methods A total of 232 neonates who were treated with mechanical ventilation in the First Affiliated Hospital of Hebei North University from June 2020 to June 2023 were selected as the research objects.The neonates with VAP were included in the VAP group,and the rest were included in the non-VAP group.The expression levels of TLR2 and TIPE2 in peripheral blood and NLR were detected and compared between the two groups.The receiver operating characteristic(ROC)curve was drawn to evaluate the value of TLR2,TIPE2,and NLR alone and in combination in predicting the occurrence of VAP in neonates with mechanical ventilation.Multivariate Logistic regression was used to analyze the influencing factors of VAP in neonates with mechanical ventilation.Results Among the 232 neonates with mechanical ventilation,60(25.86%)had VAP and were included in the VAP group.The remaining 172 patients without VAP were included in the non-VAP group.There were statistically significant differences in the mechanical ventilation time,the number of catheterization and the number of sputum suction between the VAP group and the non-VAP group(P<0.05).The relative expression level of TLR2 and NLR in VAP group were higher than those in non-VAP group,and the relative expression level of TIPE2 in VAP group was lower than that in non-VAP group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that mechanical ventilation time≥3 days,intubation times≥2 times,sputum suction times≥5 times/day,increased relative expression of TLR2 and increased NLR were risk factors for VAP in neonates with mechanical ventilation(P<0.05).The increased relative expression level of TIPE2 was a protective factor for VAP in neonates(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of TLR2,TIPE2 and NLR for predicting VAP in neonates with mechanical ventilation was 0.783,0.754 and 0.745 respectively.The AUC of combined detection of TLR2,TIPE2,and NLR in peripheral blood for predicting VAP in neonates with mechanical ventilation was 0.823.Conclusion TLR2,TIPE2 and NLR in peripheral blood are all independent influencing factors for the occurrence of VAP in neonates with mechanical ventilation,and the combined detection can help to predict the occurrence of VAP.