肺损伤程度及其预后与血清中性粒细胞弹性蛋白酶活性的关系  

Association of severity and prognosis of pulmonary injury with activity of serum neutrophil elastase

作　　者：揭志军[1] 罗勇[2] 徐卫国[1] 林建海[1] 蔡映云[3] 宋志芳[4] 

机构地区：[1]上海第二医科大学附属新华医院呼吸内科,上海市200092 [2]上海第二医科大学附属新华医院急诊科,上海市200092 [3]复旦大学附属中山医院肺科,上海市200032 [4]上海第二医科大学附属新华医院成人重症监护室,上海市200092

出　　处：《中国临床康复》2005年第35期96-98,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的：观察急性肺损伤患者血清中性粒细胞弹性蛋白酶、α_1-抗胰蛋白酶活性、α_1-抗胰蛋白酶水平及炎性因子变化，并与健康者比较，同时分析弹性蛋白酶活性与急性肺损伤严重程度及预后的相关性。 方法：①选择2003-10／2004-03新华医院成人重症监护和外科监护病房收治的急性肺损伤患者35例。纳入急性肺损伤患者22例，男13例，女9例；年龄25～75岁，平均(45±10)岁。均对实验目的知情同意。②根据患者的预后分为2组，死亡组(n=10)和存活组(n=12)。选择同期门诊健康体检志愿者15例为对照组。均对实验目的知情同意。③抽取纳入对象静脉血，血清中弹性蛋白酶活性的测定采用比色法；α_1-抗胰蛋白酶水平测定采用速率散射比浊法，α_1-抗胰蛋白酶活性按Dietz法进行测定；白细胞介素6和8水平测定采用双抗体夹心ABC-酶联免疫吸附法。④多组计量资料间比较采用单因素方差分析，两组间比较采用LSD-t检验。两变量间的相关性用Spearman等级相关分析法。 结果：急性肺损伤患者22例和健康者15例均进入结果分析。①死亡组和存活组患者血清弹性蛋白酶活性、白细胞介素6和白细胞介素8水平均明显高于对照组(P<0．05)，α_1-抗胰蛋白酶活性明显低于对照组(P<0．01，0．05)。死亡组患者血清弹性蛋白酶活性、白细胞介素6和白细胞介素8明显高于存活组(P<0．05～0．01)，α_1-抗胰蛋白酶活性明显低于存活组(P<0．01)。②急性肺损伤患者血清弹性蛋白酶活性与动脉血氧分压／吸入氧分数值呈显著负相关(r=-0．874，P<0．01)。 结论：①急性肺损伤患者的弹性蛋白酶活性明显升高，α_1-抗胰蛋白酶活性显著降低，出现蛋白酶-抗蛋白酶失衡，伴有炎性介质白细胞介素6和8的增加，这可能是引起肺组织损伤的重要原因。②血清弹性蛋白酶活性与患者的肺损伤严重程度和预�AIM： To observe the activity of serum neutrophil elastase and α1-antitrypsin, level of m-anti-trypsin and changes of inflammatory factors in patients with acute lung injury （ALl）, and compare with the healthy people. Meanwhile, to analyze the correlation of activity of elastase with injured degree and prognosis of ALl. METHODS： ① Thirty-five patients with ALl, who were treated at the Mature Intensive Care Unit and Surgical Care Unit, Xinhua Hospital from October 2003 to March 2004, were selected. Twenty-two patients with ALl were included, including 13 males and 9 females aged from 25 to 75, averagely （45±10） years old, and they were all agreed to take part in the experiment. ② The patients were assigned into 2 groups according to prognosis： Death group （n=10） and survival group （n=12）. Fifteen healthy volunteers, who had health examination at the out-patient clinic at the same period, were selected as control group. They were all agreed to take part in the experiment. ③ The venous blood was extracted from the ineluded people. The activity of elastase in serum was detected with chromatometry; The level of α1-anti-trypsin was detected with ratenephelometry; The activity of α1-anti-trypsin was detected with Dietz method; The levels of interleukin 6 and 8 were detected with double-sandwich ABC-enzyme-linked immuno-sorbent assay （ELISA）. ④ The measurement data of multiple group were compared with single factor analysis of variance, and the comparison between two groups was performed with LSD t-test. The correlation between two variances was analyzed with Spearman rank correlation analysis. RESULTS： Twenty-two patients with ALl and 15 healthy people were all involved in the result analysis. ① The activity of elastase in serum, levels of interleukin 6 and 8 in patients in the death group and survival group were all higher significantly than those in the control group （P 〈 0.05）, and the activity of α1-anti-trypsin was significantly lower than that in the control group �

关 键 词：肺/损伤 胰肽酶 Α1-抗胰蛋白酶 预后 

分 类 号：R364.4[医药卫生—病理学]