机械通气与非机械通气新生儿血清sTREM-1、CC16水平对呼吸机相关性肺炎的预测价值  

Predictive value of serum sTREM-1 and CC16 levels in ventilator-associated pneumonia in neonates with and without mechanical ventilation

作　　者：王婷婷 郭华 耿宝 范雪爱 WANG Ting-ting;GUO Hua;GENG Bao;FAN Xue-ai(Department of Neonatology,the Third Hospital of Xingtai City,Hebei Province,Xingtai 054000,China)

机构地区：[1]河北省邢台市第三医院新生儿科,河北邢台054000

出　　处：《河北医科大学学报》2023年第10期1178-1184,共7页Journal of Hebei Medical University

基　　金：邢台市科技局重点研发计划项目(2020ZC265)。

摘　　要：目的研究机械通气与非机械通气新生儿血清中可溶性髓系细胞触发受体1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)、克拉拉细胞分泌蛋白(Clara cell secretory protein,CC16)的表达及对呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的预测价值。方法选择重症加强护理病房新生儿183例,根据是否行机械通气,将患儿分成机械通气组(n=138)和非机械通气组(n=45),检测2组临床资料和不同时间段血清sTREM-1和CC16表达水平。将机械通气组患儿分成VAP组(n=63)和非VAP组(n=75),比较2组临床资料和不同时间段血清sTREM-1和CC16表达水平。Logistic回归分析确定VAP发生的影响因素,通过受试者工作特征曲线(receiver operating characteristic,ROC)曲线分析各指标对VAP的诊断效能。结果机械通气组患儿Apgar评分明显低于非机械通气组,Lac明显高于非机械通气组(P<0.05);随时间延长,2组血清CC16水平均呈降低趋势,机械勇气组血清CC16水平低于非机械通气组;2组血清sTREM-1水平均呈先升高后降低趋势,机械勇气组血清sTREM-1水平高于非机械通气组,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。VAP组Apgar评分低于非VAP组,C反应蛋白高于非VAP组(P<0.05);随时间延长,2组血清CC16水平均呈降低趋势,VAP组血清CC16水平低于非VAP组;2组血清sTREM-1水平均呈先升高后降低趋势,VAP组血清sTREM-1水平高于非VAP组,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,48 h血清CC16、72 h血清CC16、拔管后48 h血清CC16、48 h血清sTREM-1、72 h血清sTREM-1和拔管后48 h血清sTREM-1水平是VAP发生的影响因素(P<0.05)。回归分析诊断VAP的敏感度和特异度显著高于各指标单独检测(P<0.05)。结论血清sTREM-1和CC16在机械通气患儿中异常表达,而机械通气不同时间段血清sTREM-1和CC16可用于预测VAP的发生,且Objective To explore the expression of serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and Clara cell protein(CC16)in neonates with and without mechanical ventilation and their predictive value in ventilator-associated pneumonia(VAP).Methods A total of 183 neonates in neonatal intensive care unit(NICU)were selected and categorized into two groups based on their utilization of mechanical ventilation:the mechanical ventilation group(n=138)and the non-mechanical ventilation group(n=45).Clinical data,as well as serum levels of sTREM-1 and CC16 at different time periods were detected in both groups.Subsequently,the mechanical ventilation group was further stratified into the VAP group(n=63)and the non-VAP group(n=75).Comparative analysis of clinical data and serum sTREM-1 and CC16 was conducted between these subgroups.Logistic regression analysis was employed to determine the factors influencing VAP occurrence,while receiver operating characteristic(ROC)curve analysis was employed to evaluate the diagnostic performance of various indicators for VAP.Results The mechanical ventilation group exhibited significantly lower Apgar scores compared with the non-mechanical ventilation group,while lactate(Lac)levels were significantly higher in the mechanical ventilation group(P<0.05).Serum CC16 levels displayed a declining trend over time in both groups,with the mechanical ventilation group demonstrating lower levels than the non-mechanical ventilation group.Conversely,serum sTREM-1 levels initially increased and subsequently decreased in both groups,with the mechanical ventilation group exhibiting higher levels than the non-mechanical ventilation group.These differences in interaction between groups,time points,and time points between groups were statistically significant(P<0.05).Within the VAP subgroup,Apgar scores were lower compared with the non-VAP subgroup,while C-reactive protein(CRP)levels were higher(P<0.05).Similarly,both subgroups displayed a declining trend in serum CC16 levels over time,with

关 键 词：呼吸 人工 婴儿 新生 肺炎 呼吸机相关性 

分 类 号：R722.135[医药卫生—儿科]