新生儿急性肺损伤血SP-A的改变及临床意义  

DETERMINATION OF SERUM PULMONARY SURFACTANT PROTEIN A AND ITS CLINICAL SIGNIFICANCE IN INFANTS WITH ACUTE LUNG INJURY

作　　者：李楠[1] 魏克伦[1] 杜凤兰[2] 陈梅[2] 

机构地区：[1]中国医科大学第二临床学院儿科,110004 [2]解放军202医院儿科

出　　处：《新生儿科杂志》2003年第3期101-103,共3页The Journal of Neonatology

摘　　要：本文动态监测新生儿急性肺损伤(ALI)患儿血清肺表面活性蛋白A(SP-A)水平变化,并探讨其临床意义。选择符合ALI诊断标准且机械通气的患儿20例,于入组和出组时(即脱机或恢复期及退院或死亡前)抽取股静脉血,病情有明显变化时反复抽血,共收集标本70例次。计算PaO_2/FiO_2值及TPV/RVET值。对照组12例同期留取血清,用免疫印迹法测定SP-A浓度。ALI患儿入组时血清SP-A水平显著高于对照组(P<0.001);7例死于ALI患儿出组时血清SP-A明显高于11例存活患儿及其入组时测定值(P<0.005和P<0.05),而11例存活患儿出组时SP-A水平明显低于其入组时测定值(P<0.05)。整个观察期间ALI患儿血清SP-A水平与其相应的PaO_2/FiO_2和TPV/RVET比值呈负相关(P均<0.001)。结论:ALI新生儿血清SP-A水平与肺损伤的严重程度密切相关,动态监测患儿血中SP-A水平有利于判断病情及预后。To dynamically assess the surfactant protein A(SP-A) concentrations in serum of new-bom infants with acute lung injury(ALI), and discuss its clinical significance of SP-A. 70 serum samples were collected from 20 AO infants under mechanical ventilation and 12 from control group. Im ALI infants, serum samples were obtained both at the time of their entry into the study(TE) and at the time of termination of ventilation(TL i.e., when the patients were weaned from ventilation or immediately prior to their death). For most patients, serum samples were also collected when their conditions altered obviously. For each blood sample collected in ALI group, arterial blood gas values and ventilator parameters were recorded to calculate PaO2/FiO2 ratio, and ultra-sound Doppler value were also recorded to calculate TPV/RVET ratio at the same time. Serum samples were stored for determination of SP-A using western dot blot method. At TE, the serum SP-A concentrations in All group were significantly higher than those of control group(P < 0.001) . In ALI group, the serum SP-A concentrations in 7 infants who died from acute respiratory distress syndromes(ARDS) were significantly higher than those of 11 infants who survived( P < 0.005) . At TL, the serum SP-A concentrations in 7 infants who died from ARDS were significantly higher than those of 11 infants who survive and also their own values at TE (P < 0.001, P < 0.005 ) , whereas the serum SP-A levels in 11 survivors were lower as compared with their own values at TE( P < 0.005). Our research also provided that the newborn infants with ALI have high pulmonary arterial pressure and were significantly higher than those of control group( P < 0.05) . During the whole observation period, serum SP-A concentrations in ALI newborn infants were inversely related to their PaO2/FiO2 ratio (r = - 0.7%) and TPV/RVET ratio (r = -0.648) . (All P < 0.001) . Serum SP-A concentration in ALI newborn infants is significantly elevated, and is proposed as serum marker of injury to epithelial and endothe

关 键 词：新生儿 急性肺损伤 临床意义 血清 肺表面活性蛋白A SP-A 急性呼吸窘迫综合征 

分 类 号：R722.1[医药卫生—儿科]