Changes in the inflammatory response of the lung during acute respiratory distress syndrome: Prognostic indicators
Changes in the inflammatory response of the lung during acute respiratory distress syndrome: Prognostic indicators
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DOI：
10.1164/ajrccm.154.1.8680703
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发表时间：
1996-07-01
影响因子：
24.7
通讯作者：
Pattishall, EN
中科院分区：
文献类型：
--
作者：
Baughman, RP;Gunther, KL;Pattishall, EN
我们研究了配对支气管肺泡灌洗（BAL）在脓毒症相关急性呼吸窘迫综合征（ARDS）患者中的应用。患者在一家机构接受评估，并在ARDS发病48小时内接受BAL支气管镜检查。治疗4天后，患者再次接受支气管镜检查和BAL检查。最初研究了58名患者，其中44名患者在4天后进行了随访支气管镜检查。ARDS组的总体30天生存率为60%。在最初的灌洗中，幸存者和非幸存者之间的中性粒细胞没有差异（幸存者：59[0-98]%；中位数[范围]；非幸存者：55[0-92]%）。随访灌洗显示存活者中性粒细胞显著下降（36% [4-89]%,p < 0.002），而非存活者中性粒细胞未见下降（70[26-95]%）。两组小鼠BAL液中IL-8初始浓度差异无统计学意义。在后续的灌洗中，存活者IL-8浓度显著下降，而非存活者则无明显下降。我们的结论是，中性粒细胞内流可能在ARDS发病一周内迅速消退。中性粒细胞的溶解与良好的预后有关。
We studied paired bronchoalveolar lavage (BAL) in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Patients were evaluated at one institution and underwent bronchoscopy with BAL within 48 h of the onset of ARDS. Patients were restudied with bronchoscopy and BAL after 4 d of treatment. Fifty-eight patients were initially studied, with 44 patients having follow-up bronchoscopy after 4 d. The overall 30-d survival for the ARDS group was 60%. In the initial lavage, there was no difference in the neutrophils between the survivors and nonsurvivors (survivors: 59 [0-98]%; Median [Range]; nonsurvivors: 55 [0-92]%). The follow-up lavage demonstrated a significant drop in the neutrophils for the survivors (36 [4-89]%, p < 0.002) which was not seen for the nonsurvivors (70 [26-95]%). Initial IL-8 concentrations in the BAL fluid were not significantly different between the two groups. In the follow-up lavage, there was a significant fall for the IL-8 concentrations for the survivors but not the nonsurvivors. We conclude that neutrophil influx in ARDS may rapidly resolve within a week of the onset of ARDS. The resolution of neutrophils was associated with a good prognosis.