Neutrophil elastase and systemic inflammatory response syndrome in the initiation and development of acute lung injury among critically ill patients
Neutrophil elastase and systemic inflammatory response syndrome in the initiation and development of acute lung injury among critically ill patients
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DOI：
10.1016/j.biopha.2007.07.003
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发表时间：
2008-06-01
影响因子：
7.5
通讯作者：
Aikawa, Naoki
中科院分区：
文献类型：
--
作者：
Fujishima, Seitaro;Morisaki, Hiroshi;Aikawa, Naoki
危重患者通常伴有全身性炎症反应综合征（SIRS），发生急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）的风险更大。在这些条件下，产生大量的各种细胞因子，通过活化中性粒细胞和释放细胞毒性分子，特别是中性粒细胞弹性酶（neutrophil elastase， NE），直接或间接地诱导组织损伤，最终导致器官功能障碍。在本研究中，我们检测了危重患者血浆中性粒细胞弹性酶- α -1抗胰蛋白酶复合物（NE- at）和交联纤维蛋白弹性酶消化（e-XDP），以阐明NE在存在或不存在SIRS的ALI和ARDS的发生和进展中的意义。我们发现急性呼吸窘迫综合征（ARDS）患者血浆NE-AT水平显著升高，特别是当满足SIRS定义时。在ALYARDS组中，血浆NE-AT与PaO2/FIO2比值降低及ALYARDS持续时间显著相关，而e-XDP无显著相关。此外，在PaO2/FIO2比值降低20%以上的亚组中，NE-AT显著升高，而e-XDP不显著升高。在非ali患者中未观察到亚组之间的这种相关性和差异。根据这些结果，我们推测NE-AT，而不是e-XDP，可能预测ALI和ARDS早期的进行性肺损伤。(C) 2007 Elsevier Masson SAS。版权所有。
Critically ill patients are commonly associated with systemic inflammatory response syndrome (SIRS) and are at a greater risk of developing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Under these conditions, large amounts of various cytokines are produced, which either directly or indirectly induce tissue injury and finally organ dysfunctions, through the activation of neutrophils and as a result of release of cytotoxic molecules, especially neutrophil elastase (NE). In the present study, we determined plasma neutrophil elastase-alpha-1 antitrypsin complex (NE-AT) and elastase digests of cross-linked fibrin (e-XDP) in critically ill patients to elucidate the significance of NE in the initiation and progression of ALI and ARDS in the presence or absence of SIRS. We found significantly increased levels of plasma NE-AT in the patients with ARDS, especially when the definition of SIRS was met. Among ALYARDS groups, plasma NE-AT, but not e-XDP, correlated significantly with the decrease in PaO2/FIO2 ratio and the duration of ALYARDS. Furthermore, NE-AT, but not e-XDP, significantly increased in subgroups whose PaO2/FIO2 ratio decreased by more than 20%. Such correlations and differences between the subgroups were not observed in the non-ALI patients. From these results, we speculate that NE-AT, but not e-XDP, may be predictive of progressive lung injury in the early stage of ALI and ARDS. (C) 2007 Elsevier Masson SAS. All rights reserved.