摘要
目的:探讨血浆中肌肉组织特异性miRNA-1、miRNA-206与机械通气患者膈肌功能的相关性及对患者撤机结局的预测价值。方法:纳入2018年5月至2019年2月在东南大学附属中大医院重症医学科接受有创机械通气治疗＞12 h的患者57例。留置膈肌电极导管监测膈肌电活动（EAdi），在持续气道正压通气（CPAP）模式下根据膈肌电信号测量患者神经通气效能（NVE）及神经机械效能（NME），超声测量患者膈肌活动度（EXdi）及膈肌厚度变异率（TFdi）。每日8∶00筛查患者是否符合撤机前条件，符合条件的患者进行30 min的低水平CPAP的自主呼吸试验（SBT），通过后予以撤机拔管并随访撤机结局。在机械通气第1天留取患者外周血标本并保存，采用实时荧光反转录-聚合酶链反应（qRT-PCR）检测血浆miRNA-1及miRNA-206表达水平。根据撤机结果将患者撤机结局分为简单撤机（20例）和非简单撤机（37例，其中困难撤机20例，延迟撤机17例），比较2组患者膈肌功能及血浆miRNA-1、miRNA-206，探讨对撤机结局有显著影响的因素并做预测价值比较。变量相关性采用Pearson相关分析。结果:57例机械通气患者，膈肌功能障碍（DD）的发生率为64.91%（37/57）。非简单撤机组患者机械通气第1天NVE、NME及血浆miRNA-1及miRNA-206水平均显著低于简单撤机组，差异均有统计学意义（P＜0.05）。血浆miRNA-1水平与NVE、NME及EXdi、TFdi无相关性（r=0.169，P=0.210；r=0.138，P=0.306；r=-0.056，P=0.255；r=0.127，P=0.345）；血浆miRNA-206水平与NVE及NME呈正相关（r=0.316，P=0.020；r=0.378，P=0.005），与EXdi、TFdi无相关性（r=-0.029，P=0.838；r=-0.059，P=0.672）。NVE、NME及血浆miRNA-1及miRNA-206水平对非简单撤机阳性预测的ROC的AUC在0.8以上，其中血浆miRNA-206水平ROC的AUC最大，为0.8608（95% CI：0.7574~0.9642），其cut-off值为42.5，敏感度为81.2%，特异度为85.0%。结论:机械通气患者第1天血浆肌肉组织特异性miRNA-1、miRNA-206与膈肌功能相关，可能对撤机结局具有良好的预测价值。
Abstract
Objective:To investigate the correlation and predictive value of diaphragm function, plasma miRNA-1 and miRNA-206 with weaning prognosis in mechanically ventilated patients.Methods:Patients who received invasive mechanical ventilation for more than 12 hours in the Department of Critical Care Medicine, Zhong da Hospital Affiliated to Southeast University from May 2018 to February 2019 and met the inclusion and exclusion criteria were included. EAdi catheter was indwelled after enrollment. NVE, NME, EXdi and TFdi were measured under CPAP. Patients were screened daily at 8:00 am, to see whether they met the conditions for weaning, and those who satisfied the conditions underwent a 30-minute CPAP (5 cmH2O) spontaneous breathing test. After passing the test, the process started and weaning outcomes were then followed up. Peripheral blood samples were collected and stored on the first day of mechanical ventilation. The expression levels of miRNA-1 and miRNA-206 in plasma were detected by RT-PCR. According to the withdrawal result, the weaning outcomes of patients were divided into simple weaning and non-simple weaning groups. Finally, the predictive value of the factors significantly associated with weaning outcomes was compared.Results:The overall incidence of diaphragm dysfunction (DD) was 64.91% in 57 patients with mechanical ventilation (37/57). NVE, NME and plasma miRNA-1 and miRNA-206 levels were significantly lower than those of the simple (P＜0.05). There was no correlation between plasma miRNA-1 levels and EXdi, TFdi, NVE and NME (r=0.169, P=0.210; r=0.138, P=0.306; r=-0.056, P=0.255; r=0.127, P=0.345); the level of plasma miRNA-206 was positively correlated with the level of neural ventilation efficacy , and the level of neuromechanical efficacy (r=0.316, P=0.020; r=0.378, P=0.005), but negatively with EXdi and TFdi (r=-0.029, P=0.838; r=-0.059, P=0.672). The AUC of NVE, NME and plasma miRNA-1 and miRNA-206 were above 0.8, and the ROC of plasma miRNA-206 had the largest AUC of 0.8608 (95%CI: 0.7574-0.9642), with a cut-off value of 42.5, a sensitivity of 81.2%, and a specificity of 85.0%.Conclusion:On the first day of mechanical ventilation, neuromechanical efficacy and plasma miRNA-1 and miRNA-206, which reflect diaphragm function, have predictive value for weaning outcome of mechanical ventilation patients.
基金项目
国家自然科学基金(82270083)
国家自然科学基金(81870066)
江苏省科技厅重点研发(社发)项目(BE2020786)
江苏省第六期“333”高层次人才培养工程项目(2022YFC2504400)
常见多发病防治研究重点专项()
万方数据