Expression Of Mucoprotein MUC5AC In Ventilator-associated Pneumonia And Its Early Diagnostic Value

Objective : By detecting the level of mucoprotein MUC5 AC in the bronchoalveolar lavage fluid of patients with ventilator-associated pneumonia in intensive care unit,to observe the expression of mucoprotein MUC5 AC in the airways of patients with ventilator-associated pneumonia.By comparing with control group,to explore its changing rules.Analyzing the relationship between it and the severity of ventilator-associated pneumonia,and then analyzing the value of the combination of procalcitonin(PCT)and simplified CPIS for early diagnosis of ventilator-associated pneumonia.Methods:A prospective study was conducted.During April 2018-March 2019 in the intensive care unit(ICU)of ous hospital,78 patients with underwent mechanical ventilation were enrolled in this study.The subjects were divided into VAP group(experimental group)and non-VAP group(control group)according to the VAP diagnostic criteria formulated.Acute Physiology and Chronic Health Evaluation score were calculated for all subjects when they were enrolled.the bronchoalveolar lavage fluid and peripheral venous blood were obtained at 1h and 48 h after tracheal intubation.The mucoprotein MUC5 AC content in BALF and the PCT level in serum were detected by ELISA,and the simplified CPIS score be calculated at the same time.Comparing the differences of PCT,mucoprotein MUC5 AC and simplified CPIS scores between groups,and analyzing the correlation between mucoprotein MUC5 ACexpression levels of mucin and simplified CPIS score.The value of the above-mentioned indicators for early diagnosis of ventilator-associated pneumonia be assessed by receiver operating characteristic curve(ROC curve).Results:1.A total of 78 patients who met the criteria were included,of which 42 cases were diagnosed in the VAP group,23 cases were male,and 19 cases were female,with an average age of(62.63±11.94)years old and APACHE?score(17.00±2.40)points.And 36 cases were diagnosed in non-VAP groups,19 cases were male,and 17 cases were female,with an average age(63.13±14.29)years and APACHE?score(16.77±2.49)points.2.There was no significant difference in the PCT mucoprotein MUC5 AC level and simplified CPIS score between experimental group and control group when intubation for 1 hour(P>0.05).After intubation for 48 hours,the PCT mucoprotein MUC5 AC level and simplified CPIS score in the VAP group were significantly higher than those within 1hour of intubation(P<0.01),and higher than those in control group(P<0.05).In the experimental group,the mucoprotein MUC5 AC level and APACHE?score of patients with simplified CPIS >6 points was higher than that of patients with simplified CPIS?6points(P<0.05).after intubation for 48 hours,mucoprotein MUC5 AC level in control group was higher than that within 1 hour of intubation(P<0.05),while PCT and simplified CPIS score showed no statistical difference(P>0.05).The expression level of mucoprotein MUC5 AC was positively correlated with CPIS and APACHE?score in all patients(P<0.05).3.Compared with the non-VAP group,the PCT,mucoprotein MUC5 AC,APACHE?score and simplified CPIS of the VAP group were significantly increased(P <0.05).The ROC results shows that the area under curve(AUC),sensitivity and specificity of thecombination of PCT,mucoprotein MUC5 AC and simplified CPIS were0.962,93.3%,86.7%.Conclusion : 1.The high expression of mucoprotein MUC5 AC is present in the respiratory tract of patients with ventilator-associated pneumonia,mucoprotein MUC5 AC oversecretion is an important factor in the progression of ventilator-associated pneumonia.Mechanical ventilation also plays an important role in the excessive mucoprotein MUC5 AC secretion.2.The combination of PCT,mucoprotein MUC5 AC and simplified CPIS can significantly improve the sensitivity and specificity of the early diagnosis of VAP.