ICU机械通气患者呼吸机相关性肺炎的危险因素及WISP1/TLR4/整合素β5通路基因变化  

Analysis of risk factors for ventilator-associated pneumonia in patients with mechanical ventilation in ICU and gene changes of WISP1/TLR4/integrin β5 pathway

作　　者：赵琰 韩雯雯 赵琳 孔兵 ZHAO Yan;HAN Wen-wen;ZHAO Lin;KONG Bing(Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University,Jinan,Shandong 250014,China;不详)

机构地区：[1]青岛大学附属山东省妇幼保健院重症医学科,山东济南250014 [2]山东单县中心医院手术室,山东菏泽254300

出　　处：《中华医院感染学杂志》2023年第23期3557-3561,共5页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展计划基金资助项目(202003051429);山东省医药卫生科技发展计划基金资助项目(2019WS426)。

摘　　要：目的分析重症监护室(ICU)机械通气患者呼吸机相关性肺炎的危险因素及Wnt1诱导的信号通路蛋白1(WISP1)/Toll样受体4(TLR4)/整合素β5通路基因变化。方法回顾性选取2018年5月-2022年12月山东省妇幼保健院及山东单县中心医院收治的ICU机械通气患者188例纳入研究,根据呼吸机相关性肺炎情况纳入呼吸机相关性肺炎组(n=49)、非呼吸机相关性肺炎组(n=139)。分析ICU机械通气患者呼吸机相关性肺炎的病原菌分布,比较两组WISP1/TLR4/整合素β5通路基因,收集患者临床资料,通过单因素、多因素分析ICU机械通气患者呼吸机相关性肺炎的危险因素。结果188例ICU机械通气患者发生呼吸机相关性肺炎49例,发生率为26.06%,共分离病原菌58株,其中革兰阴性菌46株,占比79.31%;呼吸机相关性肺炎组WISP1信使核糖核酸(mRNA)、TLR4 mRNA、整合素β5 mRNA表达水平高于非呼吸机相关性肺炎组(P<0.05);多因素Logistic分析结果显示,机械通气时间≥20 d、WISP1 mRNA、TLR4 mRNA、整合素β5 mRNA表达水平升高为ICU机械通气患者呼吸机相关性肺炎的危险因素(P<0.05)。结论ICU机械通气患者呼吸机相关性肺炎主要病原菌为革兰阴性菌,WISP1/TLR4/整合素β5通路基因可能参与ICU机械通气患者呼吸机相关性肺炎的发生,多种因素与ICU机械通气患者呼吸机相关性肺炎发生密切相关。OBJECTIVE To analyze the risk factors of ventilator-associated pneumonia in patients with mechanical ventilation in the intensive care unit(ICU)and the gene changes of WNT1-induced signaling pathway protein 1(WISP1)/Toll-like receptor 4(TLR4)/integrin β5 pathway.METHODS A total of 188 patients with mechanical ventilation in ICU admitted to Shandong Maternal and Child Health Hospital and Shandong Shanxian Central Hospital from May 2018 to Dec 2022 were retrospectively collected in the study,which were divided into the ventilator-associated pneumonia group(n=49)and the non-ventilator-associated pneumonia group(n=139)according to whether the ventilator-associated pneumonia occurred.The pathogenic bacteria distribution of ventilator-associated pneumonia in patients with mechanical ventilation in ICU was analyzed,and gene expression of WISP1/TLR4/integrin β5 pathway were compared between the two groups.Clinical data of patients were collected,and the risk factors for ventilator-associated pneumonia in patients with mechanical ventilation in ICU were analyzed by univariate and multivariate analysis.RESULTS Ventilator-associated pneumonia occurred in 49 of 188 patients with mechanical ventilation in ICU,with the incidence rate was 26.06%.A total of 58 strains of pathogenic bacteria were isolated,among which 46 strains were gram-negative bacteria,accounting for 79.31%.The expression levels of WISP1 messenger ribonucleic acid(mRNA),TLR4 mRNA and integrin β5 mRNA in the ventilator-associated pneumonia group were higher than those in the non-ventilator-associated pneumonia group(P<0.05).Multivariate logistic analysis showed that mechanical ventilation duration≥20 d,increased expression levels of WISP1 mRNA,TLR4 mRNA and integrin β5 mRNA were risk factors for ventilator-associated pneumonia in patients with mechanical ventilation in ICU(P<0.05).CONCLUSION The main pathogens of ventilator-associated pneumonia in ICU patients with mechanical ventilation were gram-negative bacteria.WISP1/TLR4/integrin β5 pathway genes mi

关 键 词：重症监护室 机械通气 呼吸机相关性肺炎 病原菌 危险因素 Wnt1诱导的信号通路蛋白1 TOLL样受体4 整合素β5 

分 类 号：R563.1[医药卫生—呼吸系统]