支气管肺泡灌洗液中的炎症因子在呼吸机相关性肺炎患者中的动态变化  

Dynamic Changes in Inflammatory Cytokines of Bronchoalveolar Lavage Fluid in Patients with Ventilator-associated Pneumonia

作　　者：孙雪东[1] 董金芳[1] 陆地[1] 茅尧生[1] 郑霞[2] 

机构地区：[1]绍兴市人民医院ICU,浙江绍兴312000 [2]浙江大学医学院附属一院ICU,浙江杭州312000

出　　处：《中华医院感染学杂志》2010年第15期2189-2191,共3页Chinese Journal of Nosocomiology

摘　　要：目的通过观察呼吸机相关性肺炎(VAP)患者的支气管肺泡灌洗液(BALF)中炎症因子的变化,同时检测血清中的相应炎症因子以预测肺部感染状况、疾病的发展趋势和预后的关系。方法前瞻性研究,随机选择2005年3月-2009年3月收住MICU、SICU、NICU建立人工气道进行机械通气的患者80例作为研究对象,入科后即刻用纤维支气管镜行机械通气时的气道管理,并进行支气管肺泡灌洗(BAL),采集BALF,同时采血,检测4个时相的血清、BALF的白介素-8(IL-8)、前降钙素(PCT)、C反应蛋白(CRP)。结果患者血清和BALF中IL-8、CRP、PCT的动态变化基本一致,即在确诊VAP时呈现高峰,随着感染的控制浓度逐步下降;BALF中IL-8在肺局部有腔室化趋势;血清中CRP的浓度始终高于BALF中的浓度,但两组间差异无统计学意义;BALF中的PCT始终高于血清,两组间差异有统计学意义(P<0.01);PCT在VAP患者的BALF中能较IL-8、CRP提前升高,但IL-8、CRP明显下降后PCT仍然处于较高水平。结论 VAP患者的BALF与血清中的炎症因子有相关性,但PCTI、L-8在BALF中浓度较高,与疾病的预后密切相关,BALF中的PCT能较血清提前预示肺部感染状况。OBJECTIVE To investigate the dynamic changes in inflammatory cytokines of bronchoalveolar lavage fluid（BALF） and serum in patients with ventilator-associated pneumonia（VAP）,and the value in evaluation of the prognosis.METHODS Eighty artificial airway patients with mechanical ventilation were prospectively studied from Mar 2005 to Mar 2009 in MICU,SICU and NICU of our hospital.All the patients were done with bronchoalveolar lavage（BAL） and blood collection at the time of the admitting to ICU ward,diagnosing as VAP,3 days after effective therapy.All the indexes of interleukin-8（IL-8）,procalcitonin（PCT）,and C-reactive protein（CRP） in BALF and serum were detected at the four phases.RESULTS The dynamic changes in inflammatory cytokines in BALF were the same with that in serum.But IL-8 in BALF had compartmentalization phenomenon.The levels of CRP in serum were higher in BALF at the all phases,but there was no significant difference between them（P0.01）.The levels of PCT in BALF increased firstly before IL-8,and CRP increased,but PCT in BALF was still at the higher levels when IL-8,and CRP had decreased.CONCLUSIONS Inflammatory cytokines of BALF in VAP patients have relation with that of serum.The levels of PCT,IL-8 in BALF are higher and have close relation with prognosis.PCT in BALF can predict the situation of pneumonia.

关 键 词：支气管肺泡灌洗液 呼吸机相关性肺炎 炎症因子 

分 类 号：R181.32[医药卫生—流行病学]