Bronchoalveolar lavage surfactant protein A, B, and D concentrations in preterm infants ventilated for respiratory distress syndrome receiving natural and synthetic surfactants
Bronchoalveolar lavage surfactant protein A, B, and D concentrations in preterm infants ventilated for respiratory distress syndrome receiving natural and synthetic surfactants
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DOI：
10.1203/01.pdr.0000054653.89527.f8
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发表时间：
2003-04-01
影响因子：
3.6
通讯作者：
Shaw, NJ
中科院分区：
文献类型：
--
作者：
Beresford, MW;Shaw, NJ
表面活性蛋白(SPS)在表面活性物质的代谢和功能中起着重要作用。对它们对临床结果的相对贡献的了解仍然不完整。外源表面活性物质的SP含量和生理效应不同。本研究的目的是测定呼吸机治疗呼吸窘迫综合征早产儿的支气管肺泡灌洗(BAL)中SP浓度，并评估其与临床结局的关系。50名随机接受天然或合成表面活性物质的早产儿在第一周每天进行洗涤，此后每周使用标准化的非支气管镜技术进行两次洗涤。用双抗体夹心法测定BAL中SP-A、SP-B和SP-D的浓度。整个队列的BAL SP-A、SP-B和SP-D浓度的中位数上升。在出生后第一周显著增加(p<；0.05)。不同结果组之间的SP-A浓度没有差异。未添加SP-B的大鼠肺组织中BAL SP-B浓度显著升高。死亡的婴儿在d2和d6的BAL SP-B浓度明显低于存活的婴儿。28天补氧婴儿BALP-D浓度在第2天和第3天显著低于空气中。BAL、SP-A和SP-D浓度在随机接受天然或合成表面活性物质的婴儿之间没有显著差异。BAL、SP-B和SP-D水平较低，但与SP-A水平无关，临床预后较差。
Surfactant proteins (SPs) play an important role in surfactant metabolism and function. Understanding their relative contribution to clinical outcome remains incomplete. Exogenous surfactants differ in their SP content and physiologic effects. The aims of this study were to measure bronchoalveolar lavage (BAL) SP concentrations from preterm infants ventilated for respiratory distress syndrome and to assess their association with clinical outcome. Fifty preterm infants randomized to receive a natural or synthetic surfactant were lavaged each day for the first week and twice weekly thereafter using a standardized nonbronchoscopic technique. BAL SP-A, SP-B, and SP-D concentrations were measured using ELISA. Median BAL SP-A, SP-B, and SP-D concentrations for the whole cohort rose. significantly during the first postnatal week (p < 0.05). SP-A concentration did not differ between outcome groups. BAL SP-B concentration rose significantly in lungs that were not supplemented with SP-B. Infants dying had significantly lower BAL SP-B concentrations on d 2 and 6 compared with survivors. BAL SP-D concentrations were significantly lower on d 2 and 3 among infants in supplemental oxygen on d 28 compared with those in air. BAL SP-A and SP-D concentrations did not differ significantly between infants randomized to receive a natural or synthetic surfactant. Lower BAL SP-B and SP-D but not SP-A concentrations were associated with worse clinical prognosis.