| 张融玮.膈肌超声结合循环miRNAs可预测呼吸机相关性肺炎的发生风险[J].内科急危重症杂志,2026,32(5):444-448 |
| 膈肌超声结合循环miRNAs可预测呼吸机相关性肺炎的发生风险 |
| Diaphragmatic ultrasound combined with circulating miRNAs predicts the risk of ventilator-associated pneumonia |
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| DOI：10.11768/nkjwzzzz.202410241149 |
| 中文关键词: 重症监护室 机械通气 呼吸机相关性肺炎 膈肌超声 miRNA -155 miRNA -21 |
| 英文关键词: Intensive care unit Mechanical ventilation Ventilator -associated pneumonia Diaphragmatic ultrasound miRNA -155 miRNA -21 |
| 基金项目:深圳市科技研发资金，基础研究专项（自然科学基金）（JCYJ20220530163601003） |
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| 中文摘要: |
| 摘要 目的：探讨膈肌超声结合循环微小RNA(miRNAs)预测重症监护室（ICU）机械通气患者呼吸机相关性肺炎（VAP）发生风险。方法：选取198例ICU机械通气患者作为研究对象，根据是否发生VAP分为VAP组（63例）和非VAP组（135例）。比较2组及VAP组不同病情程度患者膈肌超声参数[膈肌增厚变化率（DTF）、平静呼吸及深呼吸膈肌移动度（DE）]及循环miRNAs（miRNA-155、miRNA-21）表达，Spearman分析膈肌超声参数及循环miRNAs表达与病情程度相关性，绘制受试者工作特征（ROC）曲线分析膈肌超声参数及循环miRNAs预测VAP发生的价值，绘制卡普兰-迈耶（K-M）生存曲线分析膈肌超声参数及循环miRNAs与VAP患者短期预后的关系。结果：198例ICU机械通气患者VAP发生率为31.82%；与非VAP组比较，VAP组DTF、平静呼吸及深呼吸DE较低，miRNA-155、miRNA-21表达较高（P均＜0.05）。与轻中度患者比较，重度患者DTF、平静呼吸及深呼吸DE较低，miRNA-155、miRNA-21表达较高（P均＜0.05）；VAP患者病情程度与DTF、平静呼吸及深呼吸DE呈负相关，与miRNA-155、miRNA-21呈正相关（P均＜0.05）。五者联合预测VAP的AUC为0.920，均高于各指标单独预测；DTF、平静呼吸DE、深呼吸DE低值亚组生存率低于高值亚组，miRNA-155、miRNA-21高值亚组生存率低于低值亚组（P均＜0.05）。结论：膈肌超声参数及循环miRNAs在ICU机械通气并发VAP患者中呈异常表达，且与病情程度密切相关，联合检测有助于提高VAP预测效能。 |
| 英文摘要: |
| Abstract Objective: To investigate the value of diaphragmatic ultrasound combined with circulating microRNAs (miRNAs) in predicting the risk of ventilator-associated pneumonia (VAP) in mechanically ventilated patients in the intensive care unit (ICU). Methods: A total of 198 mechanically ventilated patients in the ICU were enrolled as research subjects. Patients were divided into VAP group (63 cases) and non-VAP group (135 cases) according to whether VAP occurred. Diaphragmatic ultrasound parameters \[diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE) during quiet breathing and deep breathing\] and the expression levels of circulating miRNAs (miRNA-155, miRNA-21) were compared between the two groups, as well as between patients with different disease severity in the VAP group. Spearman correlation analysis was performed to explore the correlations between diaphragmatic ultrasound parameters and circulating miRNAs expression with disease severity. Receiver operating characteristic (ROC) curve was plotted to analyze the value of diaphragmatic ultrasound parameters and circulating miRNAs in predicting the occurrence of VAP. Kaplan-Meier (K-M) survival curve was plotted to analyze the relationship between diaphragmatic ultrasound parameters, circulating miRNAs and the short-term prognosis of VAP patients. Results: The incidence of VAP among the 198 mechanically ventilated ICU patients was 31.82%. The VAP group had lower DTF and DE during quiet breathing and deep breathing, and higher expression levels of miRNA-155 and miRNA-21 than those of non-VAP group (all P< 0.05). Severe patients had lower DTF and DE during quiet breathing and deep breathing, and higher expression levels of miRNA-155 and miRNA-21 than in patients with mild to moderate disease (all P< 0.05). In VAP patients, disease severity was negatively correlated with DTF and DE during quiet breathing and deep breathing, and positively correlated with miRNA-155 and miRNA-21 expression (all P< 0.05). The AUC of the combined prediction of the five indicators for VAP was 0.920, which was higher than that of each single indicator. Patients in the low-value subgroups of DTF, quiet breathing DE and deep breathing DE had lower survival rates than those in the high-value subgroups, while patients in the high-value subgroups of miRNA-155 and miRNA-21 had lower survival rates than those in the low-value subgroups (all P< 0.05). Conclusion: Diaphragmatic ultrasound parameters and circulating miRNAs are abnormally expressed in ICU mechanically ventilated patients complicated with VAP, and are closely related to disease severity. Combined detection of these indicators helps to improve the predictive efficacy for VAP. |
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