血浆microRNA-206联合床旁超声膈肌功能预测老年机械通气患者撤机结果的价值

Value of plasma microRNA-206 combined with diaphragmatic function by bedside ultrasound in predicting the outcome of weaning from mechanical ventilation in elderly patients

摘要:

目的 观察血浆microRNA-206（miRNA-206）与床旁超声膈肌功能联合预测老年机械通气患者撤机结果的价值。方法 选取2020年6月—2023年6月在南京医科大学附属淮安第一医院急诊重症监护室住院的老年机械通气患者102例，根据撤机结果分为成功组、失败组。比较两组患者血浆miRNA-206、膈肌功能指标及一般资料；采用多因素逐步Logistic回归模型分析老年机械通气患者撤机结果的影响因素；绘制受试者工作特征（ROC）曲线分析血浆miRNA-206、床旁超声膈肌功能单独及联合对老年机械通气患者撤机结果的预测价值。结果 102例患者撤机失败率为33.33%。与成功组比较，失败组膈肌增厚率（DTF）、膈肌活动度（DE）、血浆miRNA-206、白蛋白（Alb）水平降低（P <0.05），膈肌收缩速度（DCV）加快（P <0.05），膈肌浅快呼吸指数（DRSBI）、急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分、早期气管切开百分率升高（P <0.05），年龄增大（P <0.05）。多因素逐步Logistic回归分析结果显示：年龄［O^R=1.089（95% CI：1.041，1.139）］、APACHE Ⅱ评分［O^R=1.079（95% CI：1.029，1.131）］、miRNA-206 ［O^R=0.663（95% CI：0.502，0.876）］、DTF［O^R=0.587（95% CI：0.389，0.887）］、DE ［O^R=0.744（95% CI：0.584，0.947）］、DCV ［O^R=1.213（95% CI：1.059，1.389）］和DRSBI［O^R=1.931（95% CI：1.029，3.622）］是老年机械通气患者撤机结果的影响因素（P <0.05）。ROC曲线分析结果显示，miRNA-206、DTF、DE、DCV、DRSBI预测老年机械通气患者撤机结果的最佳截断值分别为0.50、34.36%、9.60 mm、1.50 cm/s、1.90 次/（min·mm），敏感性分别为73.53%（95% CI：0.556，0.871）、67.65%（95% CI：0.495，0.826）、61.76%（95% CI：0.436，0.778）、70.59%（95% CI：0.525，0.849）、64.71%（95% CI：0.465，0.803），特异性分别为70.59%（95% CI：0.583，0.810）、73.53%（95% CI：0.614，0.835）、75.00%（95% CI：0.630，0.847）、72.06%（95% CI：0.599，0.823）、79.41%（95% CI：0.679，0.883），曲线下面积（AUC）分别为0.709、0.715、0.645、0.742、0.719；联合预测的敏感性为97.06%（95% CI：0.847，0.999），特异性为69.12%（95% CI：0.567，0.798），AUC为0.851。结论 血浆miRNA-206联合床旁超声膈肌功能对老年机械通气患者撤机结果具有较高的预测价值。

Abstract:

Objective To determine the value of plasma microRNA-206 (miRNA-206) combined with diaphragmatic function by bedside ultrasound in predicting the outcome of weaning from mechanical ventilation in elderly patients.Methods A total of 102 elderly patients undergoing mechanical ventilation in the emergency intensive care unit of our hospital from June 2020 to June 2023 were selected. They were divided into success group and failure group according to the outcome of weaning from mechanical ventilation. The plasma level of miRNA-206, indicators for diaphragmatic function and general data were compared between the success group and the failure group. The multivariable stepwise Logistic regression model was applied to analyze the factors influencing the outcome of weaning from mechanical ventilation in elderly patients. The receiver operating characteristic (ROC) curves were plotted to analyze the values of plasma miRNA-206, diaphragmatic function by bedside ultrasound and their combination in predicting the outcome of weaning from mechanical ventilation in elderly patients.Results The rate of weaning failure among the 102 patients was 33.33%. Compared with the success group, the diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and levels of plasma miRNA-206 and albumin (Alb) were lower (P < 0.05), the diaphragmatic contraction velocity (DCV) was greater (P < 0.05), the diaphragmatic rapid shallow breathing index (DRSBI), the Acute Physiology and Chronic Health Evaluation II(APACHE II) score and the proportion of early tracheotomy were higher (P < 0.05), and the age was older (P < 0.05) in the failure group. Multivariable Logistic regression analysis (inclusion of variables with P-value < 0.05 and exclusion of variables with P-value >0.10) showed that age [O^R = 1.089 (95% CI: 1.041, 1.139) ], APACHE Ⅱ score [O^R = 1.079 (95% CI: 1.029, 1.131) ], plasma level of miRNA-206 [O^R = 0.663 (95% CI: 0.502, 0.876) ], DTF [O^R = 0.587 (95% CI: 0.389, 0.887) ], DE [O^R = 0.744 (95% CI: 0.584, 0.947) ], DCV [O^R = 1.213 (95% CI: 1.059, 1.389) ] and DRSBI [O^R = 1.931 (95% CI: 1.029, 3.622) ] were factors affecting the outcome of weaning from mechanical ventilation in elderly patients (P < 0.05). The ROC curve analysis demonstrated that the optimal cut-off values of miRNA-206, DTF, DE, DCV and DRSBI for predicting the outcome of weaning from mechanical ventilation in elderly patients were 0.50, 34.36%, 9.60 mm, 1.50 cm/s and 1.90 time/(min?mm), with the sensitivities being 73.53% (95% CI: 0.556, 0.871), 67.65% (95% CI: 0.495, 0.826), 61.76% (95% CI: 0.436, 0.778), 70.59% (95% CI: 0.525, 0.849) and 64.71% (95% CI: 0.465, 0.803), the specificities being 70.59% (95% CI: 0.583, 0.810), 73.53% (95% CI: 0.614, 0.835), 75.00% (95% CI: 0.630, 0.847), 72.06% (95% CI: 0.599, 0.823) and 79.41% (95% CI: 0.679, 0.883), and the areas under the ROC curves (AUCs) being 0.709, 0.715, 0.645, 0.742 and 0.719. The sensitivity, specificity and the AUC of combined detection of the above indicators for predicting the outcome of weaning from mechanical ventilation in elderly patients were 97.06% (95% CI: 0.847, 0.999), 69.12% (95% CI: 0.567, 0.798) and 0.851, respectively.Conclusions Plasma miRNA-206 combined with diaphragmatic function by bedside ultrasound has a high predictive value for the outcome of weaning from mechanical ventilation in elderly patients.