肺泡灌洗液和血浆中外泌体含量与早期急性呼吸窘迫综合征患者肺损伤严重程度及预后的关系  

Clinical study on the relationship between the exosomes in bronchoalveolar lavage fluid and plasma and the severity of lung injury and outcome in early acute respiratory distress syndrome patients

作　　者：王皓飞 胡文瀚 宋倩文 杨疏合 马晨诚 吴昌德 李卿[1] 张曦文[1] 潘纯[1] 黄英姿[1] Wang Haofei;Hu Wenhan;Song Qianwen;Yang Shuhe;Ma Chencheng;Wu Changde;Li Qing;Zhang Xiwen;Pan Chun;Huang Yingzi(Department of Critical Care Medicine,Zhongda Hospital Affiliated to Southeast University/Jiangsu Provincial Key Laboratory of Critical Care Medicine,Southeast University,Nanjing 210000,China)

机构地区：[1]东南大学附属中大医院重症医学科,江苏省重症医学重点实验室,南京210000

出　　处：《中华医学杂志》2022年第13期935-941,共7页National Medical Journal of China

基　　金：国家自然科学基金(81971812);江苏省自然科学基金(BK20191264);江苏省卫生健康委科研重点项目(ZDB2020009);江苏省重点研发计划(社会发展)项目(BE2021734)。

摘　　要：目的探讨急性呼吸窘迫综合征(ARDS)患者肺泡灌洗液(BALF)和血浆中外泌体含量与肺损伤严重程度及其预后的相关性。方法选取从2020年8月至2021年4月在东南大学附属中大医院重症医学科就诊并接受有创机械通气的患者,根据其是否是ARDS分为ARDS组和非ARDS组。最终纳入ARDS患者33例,男18例,女15例,年龄(65.5±15.5)岁;非ARDS患者10例,男8例,女2例,年龄(57.2±15.3)岁。分别采集两组患者纳入后24 h内的BALF和血浆并利用超速离心获取标本的总外泌体,利用纳米颗粒跟踪分析(NTA)检测并比较两组的外泌体含量差异,分析外泌体含量与ARDS患者肺损伤严重程度和预后的相关性。结果ARDS组与非ARDS组间性别、年龄差异均无统计学意义(均P>0.05)。ARDS组血浆中外泌体含量明显高于非ARDS组[(25.3±1.2)个/ml比(24.2±1.6)个/ml,P=0.031],而ARDS组BALF中外泌体含量同样高于非ARDS组[(26.5±1.6)个/ml比(24.6±1.1)个/ml,P=0.001]。肺内原因导致的ARDS患者BALF中外泌体含量高于肺外原因导致的ARDS组[(26.9±1.5)个/ml比(25.2±0.9)个/ml,P=0.01],而细菌性感染是其BALF中外泌体含量最高的亚组。轻度ARDS组比重度ARDS组BALF中的外泌体含量明显更低[(25.7±1.3)个/ml比(27.2±1.5)个/ml,P=0.038];ARDS患者BALF中外泌体的含量与P/F呈负相关性(r=-0.38,P=0.03);与Murray肺损伤评分水平呈正相关性(r=0.47,P=0.01);与驱动压水平、静态顺应性水平、住院时间、机械通气时间和28 d预后均无相关性(均P>0.05)。结论与非ARDS患者相比,ARDS患者BALF和血浆中外泌体含量明显增高;BALF来源的外泌体与ARDS肺损伤严重程度存在一定相关性。Objective To investigate the relationship between the levels of exosomes in bronchoalveolar lavage fluid(BALF)and plasma and the severity of lung injury and its outcome in patients with acute respiratory distress syndrome(ARDS).Methods Patients who were admitted to the Department of Critical Care Medicine,Zhongda Hospital Affiliated to Southeast University and received invasive mechanical ventilation were selected from August 2020 to April 2021,and they were divided into ARDS group and non-ARDS group.Finally,33 ARDS patients were included,including 18 males and 15 females,aged(65.5±15.5)years;10 non-ARDS patients,8 males and 2 females,aged(57.2±15.3)years.The BALF and plasma of the two groups of patients were collected within 24 hours after enrollment,and the total exosomes of the samples were collected by ultracentrifugation.Nanoparticle tracking analysis(NTA)was used to detect and compare the differences in exosome content between the two groups.Correlation of content with the severity and prognosis of lung injury in ARDS patients.Results There was no significant difference in gender and age between ARDS group and non-ARDS group(both P>0.05).The exosome in plasma of ARDS group was significantly higher than that of non-ARDS group[(25.3±1.2)/ml vs(24.2±1.6)/ml,P=0.031],while the exosomes in BALF of ARDS group was also higher than that of non-ARDS group[(26.5±1.6)/ml vs(24.6±1.1)/ml,P=0.001].The exosomes in BALF of patients with ARDS caused by intrapulmonary causes was higher than that in ARDS group caused by extrapulmonary causes[(26.9±1.5)/ml vs(25.2±0.9)/ml,P=0.01],and the infection caused by bacterial shows that the highest exosome level in BALF.The exosomes in the BALF of the mild ARDS group was significantly lower than that of the severe ARDS group[(25.7±1.3)/ml vs(27.2±1.5)/ml,P=0.038];the exosomes in BALF of ARDS patients was negatively correlated with P/F ratio(r=-0.38,P=0.03);and it was positively correlated with Murray lung injury score(r=0.47,P=0.01).However,the static compliance levels,lengt

关 键 词：呼吸窘迫综合征 成人 肺泡灌洗液 血浆 外泌体 肺损伤 病例对照研究 

分 类 号：R563.8[医药卫生—呼吸系统]