无创机械通气对慢阻肺急性发作患者骨骼肌泛素体系基因表达影响的相关性研究

目的探讨慢阻肺急性发作患者无创机械通气后骨骼肌泛素体系基因表达的变化及相关性。方法根据慢阻肺急性发作患者是否使用无创机械通气情况分为无创机械通气治疗组38例,无创机械通气对照组42例,监测并记录治疗前及治疗后14d的血气分析及肺功能;治疗后14d进行肌肉活检,使用RT-PCR检测骨骼肌泛素及核糖体蛋白S21(PRS21)的mRNA的表达。结果治疗14d后,无创机械通气治疗组Pa CO2、Pa O2、PH及FEV1%较对照组均有明显改善(P0.05);骨骼肌RPS21、泛素的mRNA的表达较对照组明显减低(P0.05);RPS21与Pa O2、PH及FEV1pro%负相关,泛素与Pa O2及FEV1%负相关,与Pa CO2正相关。治疗组的RPS21、泛素、Pa CO2、FEV1的ROC曲线下的面积分别为0.771、0.885、0.821、0.734,分别取103.978、8.128、45.350、51.350为截断点,评价酸中毒的敏感性均为90.9%,特异性分别为75%,75%,50%,50%。结论从骨骼肌基因水平上证实了无创机械通气治疗AECOPD患者的有效性。

Impact of noninvasive positive pressure ventilation on the gene expression of ubiquitin system of skeletal mus- cle in patients with AECOPD

Objective To investigate the change and relativity of NIPPV on the gene expression of ubiquitin system of skeletal muscle in patient with AECOPD. Methods 80 patients with AECOPD were divided into two groups based on whether the NIPPV treatment was given or not, 38 cases in the study group and 42 in the control group. The blood gas analysis and pulmonary function were monitored and recorded before and 14 days after treat-ment. A skeletal muscle biopsy was performed 14 days after therapy. The mRNA expression of ribosomal protein S21(RPS21)and ubiquitin in skeletal muscle cell were measured by RT-PCR. Results After 14 days treatment, the levels of PaCO2 , PaO2 , PH and FEV1% in the NIPPV group improved much better than in the control group(P<0. 05). The gene expression of RPS21 and ubiquitin was obviously lower in the study group than in the control group(P<0. 05). The level of RPS21 was negatively related with PaO2, PH and FEV1%, and the level of ubiquitin was negatively related with PaO2 and FEV1%, but positively correlated with PaCO2 . The area under the ROC curves of RPS21, ubiquitin, PaCO2 and FEV1% were 0. 771, 0. 885, 0. 821 and 0. 734 respectively in the study group. The cut-off points were 103. 978, 8. 128, 45. 350 and 51. 350 respectively. The sensitivity evaluation of acid poisoning was 90. 9%, and the specificities for each were 75%, 75%, 50% and 50%. Conclusion NIPPV is effective for AECOPD patients through the gene expression of ubiquitin system of skeletal muscle.