支气管肺泡灌洗液炎性因子及肺泡表面活性蛋白与新生儿急性呼吸窘迫综合征的关系  

Relationships of inflammatory cytokines and pulmonary surfactant protein in bronchoalveolar lavage fluid with neonatal acute respiratory distress syndrome

作　　者：李小鸥[1] 黄红丽[2] 方成志[1] LI Xiao-ou;HUANG Hong-li;FANG Cheng-zhi(Department of Neonatology,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China;Department of Pediatrics,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院新生儿科,湖北武汉430060 [2]武汉大学人民医院儿科,湖北武汉430060

出　　处：《中华实用诊断与治疗杂志》2022年第8期809-813,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81000094)。

摘　　要：目的观察急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)新生儿支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)炎性因子、肺泡表面活性蛋白(surfactant protein,SP)水平变化,探讨其与新生儿发生ARDS的相关性。方法需机械通气的ARDS新生儿30例为ARDS组,根据氧合指数分为轻度组(氧合指数4.0~<8.0)11例,中度组(氧合指数8.0~<16.0)12例,重度组(氧合指数≥16.0)7例;因其他疾病需机械通气新生儿25例为对照组。比较ARDS组与对照组应用肺表面活性物质、脓毒症、窒息比率及机械通气时间等。ARDS组于呼吸机上机前、上机24 h时、撤机前,对照组于呼吸机上机前收集BALF,采用ELISA法检测BALF白细胞介素(interleukin,IL)-6、IL-10、IL-17、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、SP-A、SP-D水平;比较上机前ARDS组与对照组及ARDS组上机前、上机24 h时、撤机前BALF IL-6、IL-10、IL-17、TNF-α、SP-A、SP-D水平,比较轻、中、重度组上机24 h时BALF IL-6、IL-10、IL-17、TNF-α、SP-A、SP-D水平。采用Pearson相关分析ARDS新生儿上机24 h时BALF SP-A水平与IL-6、IL-10、IL-17、TNF-α水平的相关性;采用多因素logistic回归分析新生儿发生ARDS的影响因素。结果ARDS组应用肺泡表面活性物质、脓毒症、窒息比率(86.67%、40.00%、46.67%)均高于对照组(20.00%、4.00%、8.00%)(χ^(2)=6.857,P<0.001;χ^(2)=7.329,P<0.001;χ^(2)=8.968,P<0.001),机械通气时间[(4.20±1.50)d]长于对照组[(1.00±0.20)d](t=2.432,P=0.004)。上机前ARDS组BALF IL-6[(198.32±10.23)ng/L]、IL-17[(118.42±73.55)ng/L]、TNF-α[(52.63±9.77)ng/L]水平均高于对照组[(125.61±10.39)、(98.03±54.91)、(42.67±15.31)ng/L](P<0.05),SP-A[(38.96±1.24)ng/L]、SP-D[(9.71±0.07)ng/L]水平均低于对照组[(45.95±1.87)、(12.62±0.05)ng/L](P<0.05),IL-10水平与对照组比较差异无统计学意义(P>0.05)。上机24 h时ARDS组BALF IL-6、IL-17、TNF-α水平均高于上机前、撤机前(P<0.05),SP-A、Objective To investigate the changes of inflammatory cytokines and pulmonary surfactant protein(SP)in bronchoalveolar lavage fluid(BALF)of neonates with acute respiratory distress syndrome(ARDS),and to investigate their relationships with neonatal ARDS.Methods Thirty neonates with ARDS requiring mechanical ventilation(ARDS group)were divided into 11patients with oxygenation index of 4.0to<8.0(mild group),12patients with oxygenation index of 8.0to<16.0(moderate group)and 7patients with oxygenation index of≥16.0(severe group).Another 25neonates requiring mechanical ventilation due to other diseases were selected as controls(control group).The percentages of patients applying SP and complicated with sepsis and asphyxia,as well as the ventilating time were compared between ARDS group and control group.The BALF was collected before ventilator support,in 24hof ventilator support and before weaning in ARDS group,and during ventilator support in control group.The levels of interleukin(IL)-6,IL-10,IL-17,tumor necrosis factor-α(TNF-α),SP-A and SP-D in BALF were detected by ELISA technique,and were compared before ventilator support between ARDS group and control group,before ventilator support,in 24hof ventilator support and before weaning in ARDS group,and in 24hof ventilator support among mild,moderate and severe groups.Pearson correlation method was used to analyze the correlations of SP-A level in BALF with IL-6,IL-10,IL-17,and TNF-αin 24hof ventilator support.Multivariate logistic regression analysis was done to study the influencing factors of neonatal ARDS.Results The percentages of patients applying SP,and with sepsis and asphyxia were higher in ARDSgroup(86.67%,40.00%,46.67%)than those in control group(20.00%,4.00%,8.00%)(χ^(2)=6.857,P<0.001;χ^(2)=7.329,P<0.001;χ^(2)=8.968,P<0.001),and the ventilating time was longer in ARDS group[(4.20±1.50)d]than that in control group[(1.00±0.20)d](t=2.432,P=0.004).Before ventilator support,the levels of IL-6,IL-17and TNF-αwere higher in ARDS group[(198.32±10.23),(11

关 键 词：急性呼吸窘迫综合征 支气管肺泡灌洗液 炎性因子 肺泡表面活性蛋白 

分 类 号：R722.1[医药卫生—儿科]