摘要
目的 评价肺组织AIM2炎性小体与胸腔镜下肺叶切除术肿瘤患者单肺通气相关肺损伤的关系及预测价值。方法 选取2019年9月—2021年12月在保定市第一中心医院和河北大学附属医院择期全麻下拟行胸腔镜下行肺叶切除术的肺癌手术全麻患者750例,术中切除肺叶时取远离病变处>8 cm以上肺组织。采用Western blot法检测肺组织黑色素瘤缺如因子2(AIM2),凋亡相关微粒蛋白(ASC)和半胱天冬酶-1前体(pro-Caspase1)的表达。采用急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南提出的诊断标准判断是否发生单肺通气相关肺损伤。采用Logistic回归分析筛选单肺通气相关肺损伤的危险因素。采用ROC曲线和精确率召回率曲线(PR曲线)预测相关危险因素诊断单肺通气相关肺损伤的准确程度。结果 最终纳入678例胸腔镜下肺癌手术患者。根据患者是否发生术后单肺通气相关肺损伤,将患者分为单肺通气肺损伤组(I组,115例)和单肺通气非肺损伤组(NI组,563例)。术后单肺通气肺损伤发生率是16.9%。I组和NI组相比较,年龄、FEV_(1)/FVC、单肺通气时间、手术时间、AIM2、ASC和pro-Caspase1的差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:年龄、FEV_(1)/FVC、单肺通气时间、AIM2、ASC和pro-Caspase1是单肺通气肺损伤的危险因素,并且通过二次敏感性分析结果发现,AIM2、ASC和pro-Caspase1蛋白表达仍是发生术后单肺通气肺损伤独立危险因素。ROC曲线和PR曲线分析显示,AIM2炎性小体预测单肺通气相关肺损伤的发生有较高的准确性。结论 肺组织AIM2炎性小体升高是胸腔镜下肺叶切除术肺癌患者单肺通气相关肺损伤的独立危险因素,且肺组织AIM2炎性小体可准确预测单肺通气相关肺损伤。
Objective To evaluate the relationship between AIM2 Inflammasome in lung tissue and ventilator-related lung injury in patients undergoing thoracoscopic lobectomy.Methods A total of 750 patients with ASA grade I or II,aged 40 to 80 years old,regardless of gender and weight 40 to 90kg,who intended to undergo thoracoscopic lung cancer surgery under elective general anesthesia were selected from the First Central Hospital of Baoding City and the Affiliated Hospital of Hebei University from September 2019 to December 2021.Lung tissue >8cm away from the lesion was taken during intraoperative lobectomy.Western blot assay was used to detect the expression of melanoma deficiency factor 2(AIM2),apoptosis-associated microprotein(ASC) and the precursor of caspase-1(pro-Caspase1).The diagnostic criteria proposed in the guidelines for Diagnosis and Treatment of acute lung injury/acute respiratory distress syndrome were used to determine the occurrence of single lung ventilation-related lung injury.According to the incidence of postoperative single lung ventilator-related lung injury,patients were divided into single lung ventilator-related lung injury group(group I) and single lung ventilator-related lung injury group(group NI).Logistic regression analysis was used to screen the risk factors of lung injury associated with single lung ventilation.ROC curve and precision recall curve(PR curve) were used to predict the accuracy of risk factors in diagnosing lung injury associated with single lung ventilation.Results A total of 678 patients undergoing thoracoscopic lung cancer surgery were included in this study.Postoperative pulmonary injury with single lung ventilation occurred in 115 patients(16.9%).There were significant differences in age,FEV_(1)/FVC,single lung ventilation time,operation time,AIM2,ASC and pro-Caspase1 between the NI group and the I group(P<0.05).Multivariate Logistic regression analysis showed that age,FEV_(1)/FVC,duration of single lung ventilation,AIM2,ASC and pro-Caspase1 were risk factors for lung injury during single lung ventilation,and the results of secondary sensitivity analysis showed that AIM2,ASC and pro-Caspase1 protein expression were still independent risk factors for lung injury after single-lung ventilation.ROC curve and PR curve showed that AIM2 inflammasome had high sensitivity and specificity in predicting the occurrence of lung injury related to single lung ventilation.Conclusion Increase AIM2 inflammasome in lung tissue is an independent risk factor for single-lung ventilator-related lung injury in patients undergoing thoracoscopic lobectomy and AIM2 inflammasome in lung tissue can accurately predict single-lung ventilator-associated lung injury.
作者
宗宇红
王磊
杜小兵
尹翔宇
许紫舸
王曼
朱蕾
ZONG Yuhong;WANG Lei;DU Xiaobing;YIN Xiangyu;XU Zige;WANG Man;ZHU Lei(Department of Anesthesiology,Baoding First Central Hospital,Baoding 071000,Hebei,China;Department of Anesthesiology,The Affiliated Hospital of Hebei University,Baoding 071000,Hebei,China)
出处
《西部医学》
2024年第1期72-78,共7页
Medical Journal of West China
基金
保定市科技计划项目(1941ZF036)。
