摘要
目的观察急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者呼出气冷凝液(EBC)中8-异前列腺素(8-iso-PG)的水平,探讨其临床价值。方法 2009年4月至2009年9月严重外伤和手术后入住南通大学第二附属医院重症监护病房(ICU)行机械通气的31例ALI/ARDS患者为研究组,根据入院第1 d和第5 d的病情变化,分为持续ALI组(10例),持续ARDS组(9例),病情加重组(ALI加重为ARDS,6例),以及病情缓解组(ARDS缓解为ALI,6例)。对ALI/ARDS患者使用改进的EcoScreen冷凝器采集EBC标本。30名健康体检者为对照组,自主呼吸收集EBC标本。采用EIA法测定EBC中8-iso-PG浓度,观察不同肺损伤分级及预后患者EBC中8-iso-PG水平的差异,并与临床指标作相关性分析。结果 ALI/ARDS患者第1 d和第5 d时EBC中8-iso-PG水平均高于对照组[(45.53±14.37)ng/L和(45.31±12.42)ng/L比(19.47±4.06)ng/L,P<0.001]。持续ALI组EBC中8-iso-PG水平在第1 d和第5 d时为(39.23±11.49)ng/L和(37.42±12.11)ng/L(P>0.05),显著低于持续ARDS组[(52.57±9.87)ng/L和(51.93±10.45)ng/L,P>0.05)]。病情加重组EBC中8-iso-PG水平在第1 d和第5 d时分别为(32.56±9.70)ng/L和(51.43±10.93)ng/L(P<0.05),病情缓解组第1 d和第5 d时分别为(58.43±13.47)ng/L和(42.42±10.42)ng/L(P<0.05)。病死组第1 d和第5 d时EBC中8-iso-PG水平为(53.94±12.25)ng/L和(57.33±10.48)ng/L,显著高于存活组[(39.16±13.65)ng/L和(36.19±7.96)ng/L,P<0.01]。EBC中8-iso-PG水平与外周血WBC、LIS评分、X线评分、AaDO2/PaO2、AaDO2、VT、VE及MEWS评分呈正相关(P<0.05),与PaO2/PAO2、PaO2/FiO2呈负相关(P<0.05)。结论 ALI患者EBC中8-iso-PG水平对判断病情严重程度和评估预后有一定的参考价值。
Objective To investigate the concentration of 8-isoprostaglandin（8-iso-PG） in exhaled breath condensate（EBC） of patients with acute lung injury/acute respiratory distress syndrome（ALI/ARDS）,and evaluate its clinical significance.Methods Thirty-one ALI/ARDS patients who received mechanical ventilation were recruited as an experimental group,and EBC was collected with improved EcoScreen condenser,while thirty normal subjects were recruited as a control group.The 8-iso-PG level in EBC was analyzed by ELISA.The ALI/ARDS patients were subdivided into a continuous ALI group（n=10）,a continuous ARDS group（n=9）,a worsening group（n=6）,and a remission group（n=6） by state of illness on 1st day and 5th day.The 8-iso-PG level in EBC of the ALI/ARDS patients with different severity and different prognosis were compared,and the correlation were analyzed between the 8-iso-PG level and clinical indicators. Results T he 8-iso-PG levels in EBC of the ALI/ARDS patients on 1st day and 5th day w ere higher than those in the control subjects respectively [（45.53±14.37） ng/ L and（45.31±12.42） ng/L vs.（19.47±4.06）ng/L,P〈0.001].The 8-iso-PG level was higher in the worsening group than the remission group,higher in the contin uous ARDS group than the continuous ALI group,and higher in the non-survival g r oup than the survival group（P〈0.05）.The 8-iso-PG level in EBC wa s positi vely correlated with white blood cell count in peripheral blood,lung injury sco re,X-ray score,AaDO2/PaO2,AaDO2,VT,VE and MEWS s core,and negatively corr elated with PaO2/PAO2 and PaO2/FiO2.Conclusion The 8-iso-PG level in EBC of ALI/ARDS patients has reference value for judging severity and prognosis of A LI/ARDS.
出处
《中国呼吸与危重监护杂志》
CAS
2012年第1期41-45,共5页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
8-异前列腺素
呼出气冷凝液
急性肺损伤/急性呼吸窘迫综合征
机械通气
8-Isoprostaglandin
Exhaled breath conden sate
Acute lung injury/Acute respiratory distress syndrome
Mechanical vent ilation
