NLR、IRF1与急性呼吸衰竭患者机械通气撤机失败的相关性研究

A Correlation Study Between NLR,IRF1 and Mechanical Ventilation Withdrawal Failure in Patients with Acute Respiratory Failure

目的探讨中性粒细胞/淋巴细胞比值(NLR)、干扰素调节因子1(IRF1)与急性呼吸衰竭(ARF)患者机械通气撤机失败的相关性。方法前瞻性选取2022年9月至2023年9月我院收治的120例重症ARF患者为研究对象,根据患者有创机械通气撤机结局分为撤机失败组与撤机成功组。比较两组通气前、通气24 h、通气48 h的NLR、IRF1水平,并分析NLR、IRF1与患者机械通气撤机失败的相关性,并评估两指标预测患者机械通气撤机失败的价值。结果120例患者中28例患者撤机失败(23.33%)。撤机失败组有创机械通气时间≥7 d占比高于撤机成功组(P<0.05);撤机失败组通气前、通气24 h、通气48 h的NLR、IRF1 mRNA水平均高于撤机成功组(P<0.05);且各时点的两指标与ARF患者机械通气撤机失败均呈正相关(r>0,P<0.05),通气48 h时r值最大。以通气48 h数据进行限制性立方样条模型(RCS)分析,NLR、IRF1与机械通气撤机失败的关联呈非线性J型剂量反应关系。Logistic回归分析,通气48 h的NLR、IRF1、有创机械通气时间≥7 d均是影响ARF患者机械通气撤机失败的相关因素(P<0.05),根据回归方程最佳截断值将患者分为低风险组和高风险组,高风险组第一次撤机期间相关并发症发生率高于低风险组(P<0.05);绘制受试者工作特征曲线图(ROC)显示,通气48 h的NLR、IRF1单独及联合预测ARF患者机械通气撤机失败的曲线下面积分别为0.776、0.937、0.952,均具有一定的预测价值,联合预测的效能相对较高。结论NLR、IRF1与ARF患者机械通气撤机失败密切相关,其机制主要涉及炎症反应,同时两指标在提示患者病情变化上有一定的辅助性作用,且NLR、IRF1对预测ARF患者机械通气撤机失败具有一定的价值。

Objective To explore the correlation between neutrophil/lymphocyte ratio(NLR),interferon regulatory factor 1(IRF1),and mechanical ventilation withdrawal failure in patients with acute respiratory failure(ARF).Methods From September 2022 to September 2023,a prospective study was conducted on 120 critically severe ARF patients admitted to our hospital.According to the outcome of invasive mechanical ventilation withdrawal,patients were divided into withdrawal failure group and withdrawal success group.NLR and IRF1 before ventilation,24 hours after ventilation and 48 hours after ventilation were compared.The correlation between NLR and IRF1 and the failure of mechanical ventilation was analyzed,and the value of two indexes in predicting the failure of mechanical ventilation was evaluated.Results After evaluation,28 patients failed to withdraw,accounting for 23.33%.The proportion of invasive mechanical ventilation time≥7 days in the withdrawal failure group was higher than that in the withdrawal success group(P<0.05).The mRNA of NLR and IRF1 in the withdrawal failure group before ventilation,24 hours after ventilation,and 48 hours after ventilation were higher than those in the withdrawal success group(P<0.05).And two indicators at each time point were positively correlated with mechanical ventilation withdrawal failure in ARF patients(r>0,P<0.05),with the highest r value at 48 hours after ventilation.The correlation between NLR,IRF1,and mechanical ventilation withdrawal failure was analyzed using a restricted cubic spline model(RCS)using 48 hours of ventilation data,and showed a non-linear J-shaped dose-response relationship.Logistic regression analysis showed that NLR,IRF1,and invasive mechanical ventilation time≥7 days after 48 hours of ventilation were all related factors affecting mechanical ventilation withdrawal failure in ARF patients(P<0.05).Patients were divided into low-risk and high-risk groups based on the optimal cutoff value of the regression equation.The incidence of related complications during the first withdrawal period in the high-risk group was higher than that in the low-risk group(P<0.05).The receiver operating characteristic curve(ROC)showed that the area under the curve of NLR,IRF1 alone and combined prediction of mechanical ventilation weaning failure in ARF patients at 48 h of ventilation was 0.776,0.937 and 0.952,respectively,which had certain predictive value,and the combined prediction efficiency was relatively high.Conclusion NLR and IRF1 are closely related to the failure of mechanical ventilation weaning in ARF patients.The mechanism is mainly related to inflammatory response.At the same time,the two indicators have a certain auxiliary role in suggesting changes in the patient′s condition,and NLR and IRF1 have certain value in predicting the failure of mechanical ventilation weaning in ARF patients.