肺泡灌洗液中SP-A水平与ARDS病情严重程度的相关性研究  

SP-A Levels in BALF correlates with the severity of ARDS in adult

作　　者：杨俊 朱涛[1,2] 王导新 邓火金[2] 李鹤[1] 祝麟[1] 何婧 邓欣雨[1] 杨艳丽[1] 宋玉燕[3] YANG Jun;ZHU Tao;WANG Daoxin;DENG Huojin;LI He;ZHU Lin;HE Jing;DENG Xinyu;YANG Yanli;SONG Yuyan(Respiratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, China;Chomgqing Public Healtb and Medical Centev, Chongqing 400010, China)

机构地区：[1]重庆医科大学附属第二医院呼吸内科,重庆400010 [2]南方医科大学珠江医院呼吸内科,广东广州510280 [3]重庆市公共卫生医疗救治中心,重庆400010

出　　处：《西部医学》2019年第1期56-59,共4页Medical Journal of West China

基　　金：广东省自然科学基金(2017A030310286);广东省科技计划项目(2016A020215099;2014A020212627);广州市科学研究专项(201707010282)

摘　　要：目的探讨急性呼吸窘迫综合征(ARDS)患者支气管肺泡灌洗液(BALF)中肺泡表面活性蛋白(SP-A)水平与氧合指数的相关性及临床意义。方法对入住医院RICU初次诊断为ARDS患者151例中根据入选标准和排除标准选取75例进行有创机械通气患者,以28天时患者是否存活分为存活组27例和非存活组48例。以横断面研究记录患者性别、年龄等基础指标;患者入RICU时的APACHEII评分、呼吸机参数(PIP、PEEP和VT)、血常规指标(WBC和NS)、PCT和氧合指数(PaO2/FiO2);入RICU时行纤维支气管镜肺泡灌洗使用ELISA检查BALF中SP-A的水平。结果结果显示存活组患者体重指数(BMI)高于非存活组患者(P<0.05),其余基础指标两组患者间无显著差异(P均<0.05)。入RICU时的APACHEII评分、呼吸机参数(PIP、PEEP和VT)、血常规指标(WBC和NS)、PCT、氧合指数(PaO2/FiO2)和BALF中SP-A的水平在存活组与非存活组之间均有显著差异(P均<0.05)。同时相关性分析显示BALF中SP-A水平与氧合指数有强相关性(R2=0.531)。结论临床研究表明非存活组患者的一般情况较存活组患者差,BALF中SP-A水平与ARDS患者病情严重程度呈正相关性,可作为ARDS的标记物。但仍需进一步的大样本多中心临床研究证实其价值。Objective To investigate whether SP-A levels in bronchoalveolar lavage fluid (BALF) correlates with the severity of ARDS in adult. Methods From May 2012 to January 2018, 151 adult patients (18 to 75 years old) with ARDS requiring invasive mechanical ventilation from RICU in our hospital were screened in our study. Finally, 75 patients were enrolled. According to whether survived in 28 days after invasive mechanical ventilation intervention, patients were divided into two groups, non-survival group (n= 48) and survival group (n= 27). Demographic characteristics, clinical data and the content of SP-A in BALF were recorded and measured on day 0. Correlation analysis was used to evaluate the relationship between SP-A level in BALF and PaO 2/FiO 2. Results Our data showed that the significant differences in body mass index (BMI), APACHEII score, PIP, PEEP, WBC, NS, PCT, PaO 2/FiO 2 and SP-A in BALF were found between survival group and non-survival group. Strong correlation between SP-A level in BALF and PaO 2/FiO 2 was observed (R 2= 0.531). Conclusion The general condition of ARDS patients in non-survival group was worse than survival group. Correlation between SP-A level in BALF and PaO 2/FiO 2 was good. Therefore, our results indicated that SP-A level in BALF could possibly be used as a predictor of the severity of ARDS in clinical practice. However, a multiple center study with larger sample size should be carried out to further assess the value of it in future.

关 键 词：急性呼吸窘迫综合征(ARDS) 肺泡灌洗液(BALF) 肺泡表面活性蛋白(SP-A) 氧合指数 相关性 

分 类 号：R563.8[医药卫生—呼吸系统]