急性肺损伤/急性呼吸窘迫综合征患者呼出气冷凝液中血管内皮生长因子A检测的临床意义  

Clinical Significance of VEGF-A in Exhaled Breath Condensate of Patients with ALI/ARDS

作　　者：蒋云书[1] 陈建荣[2] 张文彬[2] 蔡映云 陶一江[1] 徐志华[2] 陶国华[1] 陈金亮[1] 

机构地区：[1]南通大学第二附属医院呼吸科,江苏南通226001 [2]南通大学第二附属医院急诊科,江苏南通226001 [3]上海复旦大学附属中山医院呼吸病研究所,上海200032

出　　处：《中国呼吸与危重监护杂志》2011年第2期135-138,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的观察急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者呼出气冷凝液(EBC)中血管内皮生长因子A(VEGF-A)的水平,并探讨其临床价值。方法纳入23例ICU中行机械通气的ALI/ARDS患者,使用改进的EcoScreen冷凝器收集EBC标本。17名健康体检者为对照组,自主呼吸收集EBC标本。采用EIA法测定EBC和血清中VEGF-A的浓度。观察不同肺损伤分级患者EBC中VEGF-A的差异,并与临床指标作相关性分析。结果 EBC中VEGF-A水平在ALI/ARDS患者低于正常对照组[(49.88±6.32)ng/L比(56.50±6.23)ng/L,P<0.01],ALI组高于ARDS组[(53.56±5.56)ng/L比(45.86±4.45)ng/L,P<0.01),存活组高于病死组[(51.92±6.28)ng/L比(46.05±4.58)ng/L,P<0.05)。EBC中VEGF-A水平与肺损伤评分(LIS)、A-aDO2/PaO2呈负相关(r值分别为-0.426和-0.510,P<0.05),与PaO2/FiO2、PaO2呈正相关(r值分别为0.626和0.655,P<0.05)。血清VEGF-A水平在ALI/ARDS患者与正常对照组、ALI组与ARDS组、存活组与死亡组之间比较,差异均无统计学意义(P均>0.05)。血清VEGF-A水平与LIS评分、A-aDO2/PaO2、PaO2/FiO2、PaO2均无显著相关性(P均>0.05)。结论 ALI/ARDS患者EBC中VEGF-A的变化可以作为肺损伤病情严重程度判断和预后评估的辅助指标。Objective To observe the level of vascular endothelium growth factor A(VEGF-A) in exhaled breath condensate(EBC) of patients with acute lung injury/acute respiratory distress syndrome(ALI/ARDS),and investigate its clinical significance.Methods EBC of 23 patients with ALI/ARDS by mechanical ventilation in intensive care unit(ICU) were collected with improved EcoScreen condenser.EBC of 17 normal control subjects were collected with EcoScreen condensor.The level of VEGF-A was measured by ELISA in EBC and serum.The levels of VEGF-A in EBC of patients with different grades of lung injuries were compared,and the correlation was analyzed between the level of VEGF-A and clinical indicators.Results The level of VEGF-A in EBC was lower in the patients with ALI/ARDS than that of control subjects [(49.88±6.32)ng/L vs.(56.50±6.323)ng/L,P<0.01],the level of VEGF-A was higher in the ALI patients than that of ARDS patients [(53.56±5.56) ng/L vs.(45.86±4.45)ng/L,P<0.01],and higher in the survival patients than that of the died patients [(51.92±6.28) ng/L vs.(46.05±4.58)ng/L,P<0.05].The level of VEGF-A in EBC was negatively correlated with lung injury score and A-aDO2/PaO2(r=-0.426 and-0.510,respectively,P<0.05),and positively correlated with PaO2/FiO2 and PaO2(r=0.626 and 0.655,respectively,P<0.05).The level of VEGF-A in serum was not different between the ALI/ARDS patients and the control subjects,between the ALI and ARDS patients,or between the survival and the died patients(all P>0.05).The level of VEGF-A in serum had no correlation with lung injury score,A-aDO2/PaO2,PaO2/FiO2,or PaO2(all P>0.05).Conclusion The changes of VEGF-A in EBC of patients with ALI/ARDS may serve as an indicator for severity and prognosis evaluation.

关 键 词：血管内皮生长因子 呼出气冷凝液 急性肺损伤 急性呼吸窘迫综合征 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]