急性呼吸窘迫综合征患者肺表面活性蛋白D的动态变化研究  

Dynamic Changes of Lung Surfactant Protein D in Patients With Acute Respiratory Distress Syndrome

作　　者：韩芳[1] 王辉[2] 倪银[1] 孙仁华[1] 屠越兴[1] 江玲芝[1] 

机构地区：[1]浙江省人民医院重症医学科,浙江省杭州市310014 [2]杭州师范大学附属医院重症医学科

出　　处：《中国全科医学》2015年第13期1541-1544,共4页Chinese General Practice

基　　金：浙江省重点科技创新团队自主设计项目(2011R50018-14)--PiCCO联合不同模式血液净化对ARDS的疗效评价及预后因素分析

摘　　要：目的了解急性呼吸窘迫综合征(ARDS)患者血清和支气管肺泡灌洗液(BALF)中肺表面活性蛋白D(SP-D)的动态变化,并探讨其临床意义。方法选取2008年12月—2013年12月入住浙江省人民医院重症医学科的ARDS患者79例。根据患者28 d内存活情况,将79例患者分为存活组56例和死亡组23例。另选取2011年1月—2013年12月在浙江省人民医院进行体检的健康成年人20例,作为对照组。存活组和死亡组患者分别于诊断后24 h内(D1)、第3天(D2)、第5天(D3)及第7天(D4)采取静脉血和BALF各2 ml;对照组成年人在体检日采取静脉血和BALF各2 ml。检测并比较3组血清和BALF中的SP-D水平。结果 (1)3组不同时间点血清中SP-D水平比较,差异有统计学意义(F总=73.26,P<0.05);3组间比较,差异有统计学意义(F组间=197.01,P<0.05);不同时间点比较,差异亦有统计学意义(F时间=168.29,P<0.05)。(2)3组不同时间点BALF中SP-D水平比较,差异有统计学意义(F总=98.71,P<0.05);3组间比较,差异有统计学意义(F组间=376.91,P<0.05);不同时间点比较,差异亦有统计学意义(F时间=125.08,P<0.05)。结论 ARDS患者血清中SP-D水平从第5天开始较对照组上升,且死亡组较存活组上升高;存活组水平在第7天下降,死亡组持续上升。ARDS患者BALF中SP-D水平在诊断初期即高于对照组;第5天时存活组水平降低,死亡组继续上升;第7天时死亡组有所下降。血清和BALF中SP-D水平的动态变化对ARDS患者的临床诊疗和预后判定有指导意义。Objective To investigate the dynamic changes of lung surfactant protein D （ SP - D ） in serum and bronchoalveolar lavage fluid（ BALF）in patients with acute respiratory distress syndrome（ ARDS）and to examine its clinical significance. Methods A total of 79 patients with ARDS treated in Zhejiang Provincial People＆#39;s Hospital ICU between December 2008 and December 2013 were included in this study. We divided the patients into two groups：the survival group（n=56）and the death group（n=23）. Another 20 healthy adults who received physical examination in Zhejiang Provincial People＆#39;s Hospital between January 2011 and December 2013 were enrolled as the control group. We sampled 2 ml of venous blood and 2 ml of BALF from each subject of the survival group and the death group on day 1（D1）,day 3（D2）,day 5（D3）and day 7（D4）after their diagnosis. We also sampled 2 ml of venous blood and 2 ml of BALF from each subject of the control group on each of the four days. The SP-D levels of serum and BALF of the three groups were tested and compared. Results （ 1 ） The SP-D levels of serum were significantly different（Ftotal =73. 26,P﹤0. 05）at different time points among the three groups. The SP-D levels of serum were significantly different（Finter-group =197. 01,P﹤0. 05）among the three groups. The SP-D levels of serum were also significantly different（ Ftime points = 168. 29, P ﹤ 0. 05 ） at different time points. （ 2 ） The SP - D levels of BALF were significantly different（Ftotal =98. 71,P﹤0. 05）at different time points among the three groups. The SP-D levels of BALF were significantly different（Finter-group =376. 91,P﹤0. 05）among the three groups. The SP-D levels of BALF were also significantly different（Ftime points =125. 08,P﹤0. 05）at different time points. Conclusion The SP-D level of serum in the subjects with ARDS began to rise higher than the control group,with the death group rising higher than the survival group;the SP-D level of serum in

关 键 词：急性呼吸窘迫综合征 肺表面活性物质相关蛋白质D 血清 支气管肺泡灌洗液 

分 类 号：R563.8[医药卫生—呼吸系统]